Domestic Partnership Statement

For all employees: Benefits eligible employees who wish to register a domestic partner with the NYU Benefits Office should use this form.

The NYU Benefits Office must approve this application before you can enroll your partner as your dependent for medical and/or dental benefit coverage.

Instructions

You may enroll your registered domestic partner as a dependent on your medical and/or dental plan. A Domestic Partnership is defined as two individuals who live together in a long-term relationship of indefinite duration, with an exclusive mutual commitment in which the Partners agree to be jointly responsible for each other's common welfare and to share financial obligations. The Partners may not be related by blood to a degree of closeness which would prohibit legal marriage in the state in which they legally reside. For more information about University Policy on Domestic Partnership, click here.

Submit this form to the NYU Benefits Office: 7 E 12 St., 2F, New York, NY 10003 (Campus mail code: 8923) with the necessary documentation and signatures.