Benefits Forms

Forms that are specific to UNCSA or frequently accessed forms are located on this page. Policies and procedures are locate in the UNCSA Policy Manual. Additional forms, policies and procedures can be found on the:

• UNC System Human Resource website
• North Carolina Office of State Human Resources website

Address or Name Change

Refer to Life Events web page for addition changes that affect benefits and payroll.

• Personnel Action Form

Retirement, Investment & Savings Programs

Refer to Retirement Benefits on the UNC System website.

• UNC Optional Retirement Program Election and Forfeiture Agreement PDF (UNC System website)
• Checklist for ORP Retirement (Word)
• Checklist for TSERS Retirement (Word)
• Phased Retirement Benefits for Tenured Faculty (PDF)

Health, Welfare & Survivor Programs

Refer to the Benefits Plans web page.

• NCFlex Enrollment & Login
• UNCSA Fitness Center membership for employees
• Claim forms for NCFlex Benefits (Dental, Vision,  Critical Illness, Cancer & Specified Disease, Flexible Spending Accounts, TRICARE Supplement)

Supplemental Disability Programs

On the UNC System website of Income Protection Benefits, are voluntary supplemental disability plans, rate sheets and a video for NC Teachers' and State Employees' Retirement System (TSERS) and for UNC Optional Retirement Program (ORP) participants.  Plan and form information such as Enrollment/Cancellation Form, Evidence of Insurability, Certificate of Insurance, Notice of Information and calculating your monthly disability premium.

Leave Policies & Forms

Refer to Leave & Holiday Time.

• Community Service Leave (NC OSHR website)
• Family Illness Leave (NC OSHR website)
• Family and Medical Leave (NC OSHR website)
• Faculty Serious Illness and Disability (UNC System website)
• FMLA - Certification of Health Care Provider for Employee's Serious Health Condition (Dept of Labor form)
• FMLA - Notice of Eligibility and Rights and Responsibilities (Dept. of Labor form)
• NC State Human Resources Employee Leave Options (NC OSHR website)

Educational Benefits

Refer to Tuition & Education Resources.

• Academic Assistance Policy (NC OSHR website)
• Application for Educational Assistance (NC OSHR website)
• Employee discount policy for UNCSA summer & community programs
• Tuition Waiver Policy (UNC System)
• Tuition Waiver Regulations (UNC System)
• Tuition Waiver Form for Faculty & Staff