Faculty/Academic Staff Forms

Benefits

Dental

• Aetna Dentist Nomination Form

FSA

• Dependent Care FSA Worksheet
• Health FSA Worksheet 
• HEART Reimbursement Act Form

Health Care

• Affidavit of Dependency
• Dependent Disability Certification Form
• Loss of Previous Coverage
• Prescription Reimbursement Claim Form (CVS/Caremark)

Other Eligible Individual (OEI)

• Other Eligible Individual Form
• Affidavit of Termination of OEI Partnership
• Taxation Info
  • Faculty 2022 |  2021
  • AY Faculty 2022 | 2021
  • Retirees 2022 | 2021

Retirement

• MSU 403(b) Retirement Plan Loan Application Form

Conflict of Interest

• Conflict of Interest in Employment
  • Information about the form

Pay, Rewards & Recognition

• Outside Work for Pay Form
  • Information about the form
• Overload Pay Pre-Authorization Form
  • Information about the form

Personal Information

• Employee and Dependent Personal Data Change Form

Time Off / Leave Programs

• Request for Time Off (PDF) (Word)
• Information for Leave of Absence - other than sabbatical (Faculty / Academic Staff)
• Sabbatical Leave Information (Faculty / Academic Staff)

Tenure

• Tenure Policy Exemption Agreement: Current Faculty
• Tenure Policy Exemption Agreement: Prospective Faculty