Forms for Employees

Benefits Forms
Type of Form	Who should use this form?
Affidavit of Domestic Partnership	Form to declare Domestic Partnership for Benefits Purposes
Dental Matrix	Detail of dental plans for FY13
Employee Accident Report [31kb, PDF]	Any employee who is injured in the line of work.
Employee Dependent Children Tuition Form	Employees who are accessing the dependent children tuition benefit
Health Insurance Matrix	Comparison of health insurance plans offered at WPI for FY13
HIPAA Authorization to Use or Disclose Protected Health Information [17kb, PDF]	This form is used by an employee who is having insurance coverage issues and needs the assistance of the HR Department. This form gives WPI/the insurance carrier the authorization to know about and discuss a certain condition the employee might have so that the coverage issue may be discussed.
Harvard Pilgrim Health Care Enrollment Form - HMO	Employees who select a Harvard Pilgrim Health Care HMO Plan must complete this enrollment form.
Harvard Pilgrim Health Care Enrollment Form - PPO	Employees who select a Harvard Pilgrim PPO Health Care Plan must complete this enrollment form.
Request for Family or Medical Leave [59kb, PDF]	Eligible employees who wish to use the Family Medical Leave Act (FMLA) benefit.
Request for On Campus Tuition Remission	Employees who will be taking classes on-campus and want to access the tuition benefit
Request for Off-Campus Tuition Reimbursement	Employees who will be taking classes off campus and want to access the tuition benefit
Travel Assistance Program	This form is for employees travelling on WPI-related business and is to be used in the event of accident or injury to self.
Tuition Exchange Program Application [171kb, PDF]	Eligible employees who have children wishing to apply for the Tuition Exchange Program.
2013 Salary Reduction Form	Authorization for retirement contributions - reflects new limits for 2013
Employment Process Forms
Type of Form	Who should use this form?
Applicant Data Record	To send to applicants who have applied for a faculty opening and did not apply through our online system
Affirmative Action Compliance Form [429kb, PDF]	Hiring managers use this form when a new employee is hired. This is used for those hiring managers who do not use the PeopleAdmin system.
Change of Personnel Status [37kb, PDF]	Managers use this form when there is a change in an employee’s status that affects the employee’s pay. For example, if the funding source that will pay the employee changes, or if the employee reduces their number of hours, etc.
Employee Referral Form [212kb, PDF]	Employees fill out this form when recommending someone for a position at WPI.
IT Access Request for Student Workers	Hiring Departments use this form to request administrative computer accounts for student employees with existing accounts that need Banner access. Submit this form directly to the IT Helpdesk via email or interoffice mail.
Graduate Student Tuition ONLY Authorization Form	Hiring managers use this form to outline payment for graduate students who will receive tuition without a stipend as part of their graduate work at WPI.
Payroll Authorization [34kb, PDF]	Hiring managers fill out this form to initiate compensation for any new employee.
IT Computer Account and Data Access Request	Hiring managers use this form for all new employees. It lets the IT department know how to set up the new employee’s accounts, computer access, data access, etc.
Request for Full or PT Faculty Appt. & Payroll Authorization Form	Hiring managers fill this out when they have completed a faculty search and are ready to offer a position to a candidate. This form also initiates compensation for the candidate and needs to be completed and signed by the department, the Provost, Budget, HR, and Payroll prior to making the official offer to the candidate.
Request for Non-Faculty Research Appointment [212kb PDF]	Hiring managers fill this out when they have completed a search for a researcher position and are ready to make an offer to a candidate. This form needs to be completed and signed by the department, the Provost, Budget, HR, and Payroll prior to making the official offer to the candidate.
Request for Staff (Non-Faculty) Appointment [99kb, PDF]	Hiring managers fill this out when they have completed a staff search and they want to offer a position to a candidate. This form needs to be completed and signed by the department, the Provost, Budget, HR, and Payroll prior to making the official offer to the candidate.
Summer Salary Authorization	Managers use this form to outline how a faculty member’s summer salary will be paid.
Personal Data Forms
Type of Form	Who should use this form?
WPI Personal Data Card [261kb, PDF]	New employees fill out this form so that HR may set-up their Banner information, begin the payroll authorization process, etc.
WPI Personal Data Change Form [PDF, 75kb]	Employees use this form to report changes in their personal information; name change, address change, etc.
Faculty Forms
Type of Form	Who should use this form?
Recommended Appointment Rank for New Full- or Part-Time Faculty at or above Associate Professor [105KB, PDF]	Used by department heads to submit a proposed rank for a faculty member.
For additional information regarding Faculty Forms please visit the Provost Office website
Finance Forms
Type of Form	Who should use this form?
For Finance Forms, including Check Requests and Expense Reports, visit the Accounting Office website.
Performance Appraisals
Type of Form	Who should use this form?
Mid-Year Review Tool	This optional tool is intended for use by employees and their supervisors in assessing progress toward achieving the performance goals set during the Performance Appraisal Process.
For all other Performance Appraisal forms visit the Performance Appraisal section of our website.

Most of these forms are in Portable Document Format (PDF), which can be filled out online and then printed on a networked printer. We highly recommend use of the Adobe Acrobat Reader® 5.0, as we have encountered some minor incompatibilities using older versions. This software is available on campus free of charge - for assistance, please contact the CCC Helpdesk at helpdesk@wpi.edu or call x5888.

IMPORTANT NOTE: On some PDF forms there are boxes in which you can type multiple lines of text - if you type beyond the borders of the box, the text will not appear when the form is printed.

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Last modified: April 05, 2013 11:32:28