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Benefits Forms
- Retiree Medical (UnitedHealthcare) Claim Form (PDF)
- Retiree Benefits Enrollment Form
- Retiree Medicare Cross Over Enrollment Form
- Retiree Medicare Part B Request for Employment Information Form
- Point-of-Service Plan (UnitedHealthcare) Claim Form (PDF)
- UnitedHealthcare Foreign Providers Claim Form (PDF)
- UnitedHealthcare Dependent Eligibility Beyond Age Limit Due to Disability (PDF)
- Dental (MetLife) Claim Form (PDF)
- Dental (MetLife) Reimbursement Direct Deposit Form (PDF)
- Important Information about Covering Dependents on Your NYU Plans
- VSP Out-of-Network Reimbursement Form
- Social Security Number/Medicare Coordination Form
- Adjusted Work Schedule for Classes (PDF)
- Graduate Student Assistantships Tuition Award Application (PDF)
- Local 3882 Tuition Reimbursement 20% (PDF)
- Portable Tuition for Dependents - Current Employee (PDF)
- Portable Tuition for Dependents - Retiree and Former Employee (PDF)
- Tuition Remission - Retiree and Former Full Time NYU Employees (PDF)
- Tuition Remission 100% for Job Related Non-Credit SCPS Courses (PDF)
- Tuition Remission Application for Non-Credit SCPS Courses (PDF)
- Job Relatedness for Employee Graduate Tuition Remission Tax Form (PDF)
- NYU-Poly Employee Application for NYU WSQ Registration
