Forms

Below is a list of forms that can be printed, completed and returned to Kelley Williams in the Personnel Office. The office is located in Corson Hall Lower Level or you can fax completed forms to 484-762-4585. If you are looking for a specific form, and do not see it in this list, please email or contact the office directly. In addition to this list, Informational Resources are available online that contain plan summaries and coverage descriptions offered by the College.

Medical INSURANCE

2014 Benefits Guide

Optum Health Bank Form  

2014 HSA Contribution Form

Future Scripts Mail Order Form

  

payroll

Timesheet
Staff Census Form
W-4
I-9
Direct Deposit Form
Address Change Form  

General Benefits 

Flexible Spending Account Health Care Claim Form
Flexible Spending Account Dependent Care Claim Form
Emeriti Retirement Health Solutions Reimbursement Benefit - Claim Form

 

Health and Safety

Incident Report Form

Student Incident Report Form

Worker's Compensation Rights

Premier Urgent Care Form

Insurance Panel Providers

Confidentiality 

Confidentiality Agreement Form

Employee or Student worker Resources and Access

Employee Resource & Access Request Form 
What you can do on this form:

  • Read Documentation regarding this form>
  • New Employee resource and access requests
  • Change Employee - request access, resource, or name change for an employee
  • New / Change Student Worker - request access with this form 
  • Remove Employee/Student Worker - let us know when an employee or student worker has left the college or your department