Forms
On this page:
- Submitting Forms with Sensitive Data
- Benefits
- Compensation
- Hiring and Managing
- Miscellaneous
- Performance Evaluation
- Tax
Submitting Forms with Sensitive Data
Some of these documents may require sensitive data such as Social Security Numbers, UIDs, banking information, and more. Documents containing sensitive data should not be scanned to email on Wright State University printers or copiers or attached to email messages. Learn how to use ProofPoint SecureShare and other alternative methods.
Some forms may take longer to download.
Benefits
Spousal Insurance Coverage
Leave of Absence Forms
- Family and Medical Leave Request Form (PDF)
- Long-Term Disability Claim Form (PDF)
- Physician certification: Return to Work Certification (PDF)
- Short-Term Disability Claim Form (PDF)
- Leave Request Form (Vacation, Sick, Parental, etc.) (PDF)
Claim Forms
- Anthem Medical Claim Form (PDF)
- Dental Claim Form (PDF)
- Flexible Spending Account Recurring Claim Form (Medical & Dependent Care) (PDF)
- Flexible Spending Account Reimbursement Form (Medical & Dependent Care) (PDF)
- Flexible Spending Account Orthodontic Claim Form (PDF)
- Home Delivery (Mail Order) Pharmacy Order Form (PDF)
- Vision (out-of-network) Claim Form (PDF)
Enrollment/Change Forms
- Health Insurance Enrollment/Change Form (PDF)
- Flexible Spending Account Election/Change Form (PDF)
- Health Savings Account Contribution Change Form (PDF)
- Medicare Secondary Payer Act Status Form (PDF)
- Short-Term Disability Enrollment Form (PDF)
Retirement Forms
Compensation
- Classified Job Audit Form (PDF)
- Personnel Action Form (PDF)
- Position Description Form (DOC)
- Salary Adjustment Request Form (PDF)
- Starting Salary Request Form (PDF)
- Unclassified Position Review Request Form (PDF)
- Unclassified Position Review Decision Form (PDF)
- Work Out of Class Form for Unclassified and Non-Bargaining Unit Classified Positions (PDF)
- Work Out of Class Form for Bargaining Unit Positions (PDF)
Hiring and Managing
Miscellaneous
- Address/Name Change Form (PDF)
- Dependent Statement for Fee Remission Authorization (PDF)
- Direct Deposit Form (PDF) Campus username and password required to access this form
- Fee Remission for Special Authorizations (PDF)
- Flexible Work Arrangement Agreement (PDF)
- Separation Clearance Form (PDF)
- Strategic Hire Form (PDF) - revised November 2020
- Temporary Employment Job Order Form (PDF)
