Benefits Forms

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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



Optical Form (for PSC- CUNY Members)


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


Weight Watchers Claim Form (For PSC-CUNY Members)