Forms
These forms are in either a .doc or a .pdf file format. To read and print the .pdf you may need to download the latest version of Adobe® Acrobat® Reader (free) from the Adobe site.
All forms must be printed, completed and signed before submission to the Payroll & Benefits Department. Electronic submission of forms is not permitted at this time.
- Cafeteria Plan Election & Enrollment Form
- Short-term Disability Enrollment
- STD Rate Calculator
- STD (Dearborn) EOI Form
- Short-term Disability Claim Form
- Group Life - Waiver of Premium Claim - Fort Dearborn
- Group Life Claim Form- The Standard
- Group Life Evidence of Insurability Form - Standard
- Vision Insurance Enrollment Form - United Healthcare
- Blue Cross Enrollment Form
- Blue Cross Change Form
- Blue Cross Cancellation Form
- Life Insurance Change Form (Shenandoah)
- Trustmark Beneficiary Change Form