Human Resources Forms

 

Need forms related to hiring, performance management, attendance or termination? Visit the Manager Toolkit forms page.

IMPORTANT: Please be aware that our address has changed. As we update the addresses on our forms, please be sure that you mail forms as follows:

Columbia University HR Benefits

615 West 131 Street, MC 8703
Floor 4 Studebaker
New York, New York 10027

Columbia University HR Disability Services

615 West 131 Street, MC 8703
Floor 4 Studebaker
New York, New York 10027

 

Disability

• Department Accident Report (PDF)
• Disability Release (PDF/Word)
• NY State Disability Form (DB450) (PDF)
• Request for Reasonable Accommodation (PDF/Word)

Benefits

• Adoption Assistance Form (PDF/Word)
• DENTAL: Aetna Columbia Dental Plan Claim Form (PDF)
• DENTAL: GHI Health Insurance Claim Form (PDF)
• FLEXIBLE SPENDING ACCOUNT: Reimbursement Request Form (PDF/Word)
• Flexible Spending Account Direct Deposit Form (PDF)
• HIPAA Privacy Authorization Form (PDF/Word)
• LIFE INSURANCE: The Standard: Beneficiary Designation Form (PDF)
• LIFE INSURANCE: The Standard: Evidence of Insurability for CT Residents (PDF)
• LIFE INSURANCE: The Standard: Evidence of Insurability for NJ Residents (PDF)
• LIFE INSURANCE: The Standard: Evidence of Insurability for NY Residents (PDF)
• MEDICAL: Aetna Medical Claim Form (PDF)
• MEDICAL: Aetna Vision Claim Form (PDF)
• MEDICAL: CIGNA Behavioral Care Out of Network Claim Form (PDF)
• MEDICAL: CIGNA Medical Claim Form (PDF)
• MEDICAL: CIGNA PCP Selection form (Word)
• MEDICAL: CIGNA Prescription Drug Claim Form (PDF)
• MEDICAL: HIP Subscriber/Member Enrollment Form (PDF)
• MEDICAL: MEDCO Prescription Drug Claim Form (PDF)
• MEDICAL: MEDCO Prescription Drug Mail Order Form (PDF)
• MEDICAL: Oxford Health Insurance Claim Form (PDF)
• MEDICAL: Oxford Student Verification Parent Affidavit Form (PDF)
• MEDICAL: Post Doctoral Medical Benefits Enrollment Form (PDF/Word)
• MEDICAL: UHC Medical Claim Form (PDF)
• MEDICAL: UHC Transition of Care Form (PDF)
• TRANSIT/PARKING: Parking Payroll Deduction Authorization (PDF/Word)
• TRANSIT/PARKING: Reimbursement Form (PDF)
• TUITION: 2110 / CU Tuition Assistance Application (PDF/Word)
• TUITION: College Tuition Scholarship (CTS) Form (PDF/Word)
• TUITION: Job Related Graduate Course Certification Application Form (PDF/Word)
• TUITION: Primary Tuition Scholarship (PTS) Application Form (PDF/Word)