Forms

Payroll Forms

General Forms

• Payment Election Form (PDF)
• Reversal of Payment Election Form (PDF)
• Election to Annualize Recurring Part-Year Compensation (PDF) 
• Federal W-4 (PDF)
• Missouri W-4 (PDF)
• City Tax Form (PDF)
• Gift, Prize, or Award Form (PDF)
• New Worker Information Form (PDF)

Telecommuting Forms

• Remote Work (Telecommuting) Agreement (PDF

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Benefits Forms

General Forms

• Return to Work Form (PDF)
• Medicare Status Form (PDF)
• Adoption Assistance Reimbursement Claim Form (PDF)

Healthcare Forms

• Retiree Enrollment Form (PDF)
• Domestic Partner Declaration Form (PDF)
• UnitedHealthcare Claim Form (PDF)
• UnitedHealthcare International Claim Form (PDF)
• Delta Dental Claim Form (PDF)
• Express Scripts Claim Form (PDF)
  To be completed only if you need to submit a claim for reimbursement
• Express Scripts Mail-Order Form (PDF)
• VSP Claim Form (PDF)

Flex Spending

• ConnectYourCare Medical Expense Reimbursement Form (PDF)
  Also known as the “Pay Me Back” form for Medical Expense
• ConnectYourCare Dependent Child Care Benefits Reimbursement Form (PDF)
  Also known as the “Pay Me Back” form for Child Care

Life Insurance

• Life Insurance Portability Rate Form (PDF)

Retirement

• Faculty Phased Retirement Program Application Form (PDF)

RMSA

• RMSA Claims Activation Form (PDF)

Tuition Assistance

• Undergraduate Employee Tuition Assistance Request Form (PDF)
• Graduate Employee Tuition Assistance Request Form – Job Related (PDF)
• Graduate Employee Tuition Assistance Request Form – Non-Job Related (PDF)
• Ex-Spouse Dependent Tuition Affidavit Form (PDF)
• Dependent Eligibility Affidavit Form (PDF)
• Spouse Tuition Assistance Request Form (PDF)
• Domestic Partner Tuition Assistance Request Form (PDF)
• Postdoctoral Appointees Tuition Assistance Form (PDF)
• Nursing Tuition Assistance Request Form (PDF)

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Compensation Forms

General

• Employee Income Verification Form (PDF)

Management Tools

• Job Description Template (DOC)
• Personnel Review Justification Form (PDF)

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Performance Management Forms

Employee Evaluation (New Condensed Format)

• Administrative/Support Evaluation Form – Condensed (RTF)
• Supervisory/Professional Evaluation Form – Condensed (RTF)

Employee Evaluation (Original Format)

• Administrative/Support Evaluation Form (DOC)
• Administrative Self Evaluation Form (RTF)
• Supervisory/Professional Evaluation Form (DOC)
• Supervisory Self Evaluation Form (RTF)

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Career and Professional Development

• Competencies for Success at Washington University
• Individual Development Plan – Guidelines and Form (PDF)
• Career Development

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Other Forms

• Public Service Loan Forgiveness Form (PDF)