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Human Resources

Benefits Forms

PLEASE NOTE: You will need to have Adobe Acrobat Reader installed on your computer in order to view most of the forms. If your computer does not have Adobe Acrobat Reader installed, you may download it for free from http://www.adobe.com/products/acrobat/readstep2.html 

Death Benefit Beneficiary Designation Card (for PSC-CUNY Members)

Delta Dental Plan (for PSC- CUNY Members)

Guardian Dental Plan (for PSC- CUNY Members)

Flexible Spending Accounts (FSA) Program 2014

GHI Forms

Health Insurance Application

Life Insurance Application (For PSC-CUNY Members)

Long Term Disability Form

Medco

NYSHIP

Optical Form (for PSC- CUNY Members)

PSC-CUNY Forms

Retirees- Instructional Staff

Retirement Program Election Form

Phased Retirement Program (PSC-CUNY)

New York City Teachers' Retirement System

Tuition Waiver 

Voluntary Savings Programs- Salary Reduction Form

WageWorks

Weight Watchers Claim Form (For PSC-CUNY Members)