2016 Benefits Program Enrollment/Change Form (pdf)

One form to enroll in most benefit programs for employees working 20+ hours per week.

Affidavit of Domestic Partnership for Benefits Eligibility (pdf)

Required to add your Domestic Partner to coverage.

Statement of Termination of Domestic Partnership (pdf)

Required to discontinue your Domestic Partner's coverage.

BCBS-MA Fitness Benefit Reimbursement Form

Application for up to $150 annual reimbursement for health club/gym membership.

Health Care Flexible Spending Account (FSA) and Health Reimbursement Account (HRA) Reimbursement Form

Health Equity application for reimbursement of qualified expenses from flexible spending accounts or health reimbursement accounts.

Health Savings Account (HSA) Reimbursement Form

Health Equity application for reimbursement from HSA accounts.

Dependent Care Reimbursement Form

Use this form to get reimbursed for dependent care services.

DC-FSA Worksheet

Use this form to determine how much to deposit into your Dependent Care Assistance Program (DCAP).

DCS Spouse Work Verification

Employee Education Assistance

Application for employee education tuition reimbursement.

Application Form for Personal Computer Loan (pdf)

The Institution offers interest-free loans from $300 to $2,500 for the purchase of a personal computer.

Application Form for Tuition Loan for Children of Employees (pdf)

If you are a regular full-time employee at the Institution, you are eligible for an interest-free loan for the higher education of your children or legal dependents.
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