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- QuickLinks
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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
- Life Insurance Enrollment Form Codes 100, 102, 103 (PDF)
- Life Insurance Enrollment Form Codes 104, 106, 107 Non-Union (PDF)
- Life Insurance Enrollment Form Code 107 SGT (PDF)
- Life Insurance Enrollment Form Code 107 PRG (PDF)
- Life Insurance Enrollment Form Code 107 Local 810 (PDF)
- Life Insurance Medical History Statement for NY Residents (PDF)
- Life Insurance Beneficiary Designation Form
- Life Insurance - Application for Conversion of Group Insurance (PDF)
- Life Insurance Claim Form for Beneficiary Benefits (PDF)
- Retirement Plan Enrollment and Investment Selection (PDF)
- STDA Salary Reduction Agreement and Investment Selection Form (PDF)
- 457(b) Salary Deferral Agreement and Investment Selection Form (PDF)
- 457(b) How to Enroll - TIAA-CREF (PDF)
- 457(b) How to Enroll - Vanguard (PDF)
- TIAA-CREF How to Enroll Online (PDF)
- TIAA-CREF Designation of Beneficiary Form - NYU Retirement Plans (PDF)
- TIAA-CREF Direct Transfer/Rollover Authorization to TIAA-CREF (PDF)
- TIAA-CREF Retirement & Supplemental Tax-Deferred Annuity Plans Enrollment Form (PDF)
- TIAA-CREF Supplemental Tax-Deferred Annuity Plan Enrollment Form (PDF)
- TIAA-CREF Notice of Name Change Form (PDF)
- Vanguard Asset Transfer Authorization (PDF)
- Vanguard Designation of Beneficiary Form (PDF)
- Vanguard Distribution Request/Direct Rollover (PDF)
- Vanguard Distribution Request/Direct Rollover - 457(b) (PDF)
- Vanguard Enrollment/Change/Beneficiary Designation Form - NYU Retirement Plans (PDF)
- Vanguard Enrollment/Change/Beneficiary Designation Form - 457(b) (PDF)
- Vanguard In-Service Withdrawal Request (PDF)
- 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 WSQ Employee Application for NYU-Poly Registration
- NYU-Poly Employee Application for NYU WSQ Registration
