Frequently Used Faculty Forms

• Change of Name/Address
  • Alden Terrace
  • Clara H. Carlson
  • Covert Ave.
  • Dutch Broadway
  • Elmont Rd.
  • Gotham Ave.
  • Stewart Manor
  • Life Insurance Designation of Beneficiary
  • NYS Teachers Retirement System
  • Employee Retirement System
  • NYS Certification (TEACH)
    • Name
    • Address
• Change of Tax Withholding
  • W-4 Federal Withholding
  • W-2104 State Withholding
• Omni Group Salary Reduction Agreement (403b)
• Healthcare
  • Dental
    • Delta Dental Enrollment Change
    • Delta Dental Claim Form
    • Delta PPO Plan Info
    • DeltaCare Plan Info
    • Payroll deductions
  • Flexible Spending
    • Dependent Care Reimbursement
    • Health Care Reimbursement
  • Health Insurance
    • Empire Enrollment Transaction Form
    • Empire Plan Information
    • Empire Schedule of Benefits
    • Empire Claim Form
    • Emblem HIP Plan Information
    • HIP-0 Enrollment Transaction Form
    • HIP-5-Copay (VYTRA) - Enrollment Transaction Form
    • HIP-LG-30-Schedule of Benefits - SBC
    • Payroll Deduction Chart 2025
  • Davis Vision
    • Claim Form
    • Enrollment Form
    • Davis Vision Plan Information
  • AFLAC Cancer Screening Wellness Benefit Claim Form
  • Request for Cancer Screening Leave
• Move-Over Form (Teachers' Request for Salary Advancement)
• Request for Leave Forms (Personal/FMLA/Child Rearing/Bereavement)
• Direct Deposit
• Deduction Codes
• Request for New ID Badge