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Employee Benefits : Forms
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Medical and Prescription
(These documents are in a PDF format)
2009 Medical & Dental Enrollment/Change Form
2008 Medical & Dental Enrollment/Change Form
Uniform Medical Claim Form
Uniform Medical Prescription Claim Form
Dental
Uniform Dental Claim Form
Insurance Eligibility (PDF Format)
Dependent Student Certification Form
Life Insurance (PDF Format)
Life Insurance Enrollment/Change
Life Insurance Evidence of Insurability
Life Insurance Change of Beneficiary
Life Insurance Conversion Form
(to continue optional life insurance at termination or retirement)
Non Smoker Certification
LTD Insurance (PDF Format)
Long Term Disability Enrollment/Change
Long Term Disability Evidence of Insurability
Name and Address (MS Word Format)
Name / Address Change Form
Retirement and Savings
PERS/LEOFF/TRS Enrollment and Member Information Form (PDF Format)
PERS/TRS/LEOFF Beneficiary Designation (PDF Format)
Supplemental Retirement Plan Enrollment/Change Form (MS Word Format)
Flexible Spending Account (PDF Format)
FSA Enrollment/Claim Form
COBRA and Self-Pay (PDF Format)
COBRA Information and Enrollment
Self-pay Information and Enrollment
Contact Information
Human Resources
400 E. University Way
Ellensburg, WA 98926
Mail Stop 7425
(509) 963-1202
Fax: (509) 963-1733
humanres@cwu.edu
Central Washington University
400 E. University Way, Ellensburg WA 98926
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