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General Forms
| Address/Name Change Form | PDF (416KB) | |
| Community Service Leave Request | | DOC (23.5KB) |
| Community Service Leave Request (Tutoring/Mentoring Option ) | | DOC (23.5KB) |
| Label Request Form | | DOC (62KB) |
| NC Prepaid Legal Services Enrollment Application | PDF (49.5KB) | |
| Payroll Deduction Cancellation | PDF (847KB) | |
| Request for Family Medical Leave | PDF (76.25KB) | |
| Request for Family Illness Leave | PDF (44.31KB) | |
| University Recreation Payroll Deduction | PDF (35KB) | |
| University Recreation Payroll Cancellation | PDF (595KB) | |
| Voluntary Shared Leave Donation Form | PDF(69.6KB) | |
| Voluntary Shared Leave Request Form | PDF (68KB) | |
Claims Forms
| Attorney Billing | PDF (417KB) | |
| Conseco Insurance Claim | PDF (379KB) | |
| Colonial Life Insurance Claim | Website | |
| AFLAC Claim | Website | |
Disability Forms
| Liberty Enrollment | PDF (79KB) | |
| Liberty Employer's Statement | PDF(318KB) | |
| Liberty Disability Claim | PDF (98KB) | |
| Liberty Late Entrant | PDF (146KB) | |
| Attending Physician's Statement | PDF(79KB) | |
| Standard Disability Claim | PDF (252KB) | |
| Standard Disability Enrollment | PDF (39KB) | |
| Standard Late Entrant Enrollment | PDF (44KB) | |
NC Flex Forms
Retirement Enrollment: Optional Retirement Plan (ORP) Forms
| AIG Valic | PDF (214KB) | |
| Fidelity | Website | |
| Lincoln | PDF (190KB) | |
| TIAA CREF | PDF (832KB) | |
For Faculty and EPA Administrative Only | | |
| ORP-1 - ORP Election Form (Complete this form when choosing any of the above ORP plans) | website | |
| ORP-3 - Optional Retirement Plan Acknowledgment for Disposition of Account Contribution | website | |
State Retirement Forms
| State Retirement Forms Website | Website | |
| TSERS | Website | |
| Beneficiary Change Form | PDF (694KB) | |
| Beneficiary for the Death Benefit | PDF (692KB) | |
(Optional) Supplemental Retirement Programs Forms
| 401(K) Enrollment (Complete the Beneficiary form (located below) when enrolling) | PDF (153.22KB) | |
| 401(K) Beneficiary Designation Form | PDF (124.6KB) | |
| 401(K) Change Form | PDF (130.64KB) | |
| 403(b) Enrollment Information | Website | |
| Auth for 403(b) Salary Reduction Agreement | PDF | |
| 457 | Website | |
State Medical Forms
| Change Form | PDF (90KB) | |
| Dependent Eligibility | PDF (27.16KB) | |
| Enrollment (NC SmartChoice Blue Options PPO Plan) | Website | |
| Medco - Prescription Drug Claim Form | PDF (44.35KB) | |
| Medco - Prescription Mail Order | PDF (61KB) | |
| Medical Claim Form (PPO Plan) | PDF (74.27KB) | |
| Authorization Form (HIPAA) | PDF (47.24KB) | |
| Prior Coverage | PDF (34.24KB) | |
| State Appeal | PDF (27.69KB) | |
