General Forms
- Family Medical Leave Request - Employee Medical Condition (PDF)
- Family Medical Leave Request - Employee's Family Member Condition (PDF)
- Family Illness Leave Request-Employee's Family Member (to be used after FML has exhausted) (PDF)
- Payroll Deduction Cancellation (PDF)
- UREC Facility Access Membership Form - Faculty & Staff (PDF)
- UREC Facility - Membership Change Form (PDF)
- Voluntary Shared Leave Request Form (PDF)
- NC529 College Savings Program Enrollment Form
Claims Forms
- Attorney Billing (PDF, 417 KB)
- Conseco Insurance Claim (PDF, 379 KB)
- Colonial Life Insurance Claim Website
Disability Forms
- Liberty Enrollment (PDF, 79 KB)
- Liberty Employer's Statement (PDF, 318 KB)
- Liberty Disability Claim (PDF, 98 KB)
- Liberty Late Entrant (PDF, 146 KB)
- Attending Physician's Statement (PDF, 79 KB)
- Standard Disability Claim (PDF, 252 KB)
- Standard Disability Enrollment (PDF, 39 KB)
- Standard Late Entrant Enrollment (PDF, 44 KB)
- Short Term and Long Term Disability is provided at no cost through the Retirement Systems for more information contact the HR Office
NC Flex Forms
- MetLife Dental ID Cards and Forms
- Flexable Spending Account Forms
- Superior Vision Forms
- Allstate Critical Illness Forms
- Allstate Cancer Forms
- VOYA Term Life Forms
- VOYA Accidental Death and Dismemberment Forms
Retirement Enrollment: Optional Retirement Plan (ORP) Forms
- TIAA CREF (PDF, 832 KB) Website
- ORP-1 - ORP Election Form (PDF)
(Complete this form when choosing any of the above ORP plans) - ORP-2 - Change of ORP Retirement Vendor(PDF)
- ORP-3 - Optional Retirement Plan Acknowledgment for Disposition of Account Contribution (PDF)
State Retirement Forms
- State Retirement Forms (website)
- Beneficiary Change Form (website)
- Beneficiary for the Death Benefit (website)
(Optional) Supplemental Retirement Programs Forms
- Supplemental Retirement Options Website
- 401(K) Empower Enrollment Form
- 457(b) Empower Enrollment Form
- 403(b) TIAA Salary Reduction Agreement(PDF)
- 457(b) TIAA Salary Reduction Agreement(PDF)
- Empower Website
- TIAA Website
State Medical Forms
- Change Form (PDF, 90 KB)
- Enrollment (NC SmartChoice Blue Options PPO Plan) Website
- State Health Plan Qualifying Life Event Supporting Documentation
- Dependent Verification Requirements document
- CVSCaremark - Prescription Drug Claim Form (PDF, 44 KB)
- CVSCaremark - Prescription Mail Order (PDF, 61 KB)
- State Appeal (PDF, 27 KB)