HR Forms

Benefit Forms

Benefit Changes

(Qualifying Life Events)

Making Changes to Benefits due to a Qualifying Life Event:

• Log into Lehigh Benefits at https://go.lehigh.edu/benefitfocus
• Click "View/Edit Your Benefits" on the right side of the screen
• Enter your changes
• Upload documentation

Medical Plan Forms

• Medical Expense Claim Form
• Spouse/Partner Surcharge Waiver Request

Dental Plan Claim Form

• United Concordia Claim Form

Domestic Partnership Forms

• Affidavit of Common Law Marriage - Employee
• Affidavit of Common Law Marriage - Spouse
• Affidavit of Domestic Partnership
• Affidavit of Tax Qualified Dependent
• Statement of Termination of Partnership
• Tax Information on Health Benefits for Domestic Partners

Family Medical Leave

• Academic Planning Form for Faculty (Provost's Office)
• Lehigh Faculty and Staff FMLA Request Form
• Certification of Healthcare Provider Form (for the employee's own serious health condition)
• Certification of Healthcare Provider Form (for a family member's serious health condition)
• Healthcare Provider's Release to Return to Work

Flexible Spending Accounts (FSA)

• WageWorks FSA Claim Forms
• WageWorks Healthcare FSA Eligible Expenses
• WageWorks Childcare Eligible Expenses

Leave Requests for Staff

• Leave of Absence Form
• Paid Parental Leave Request Form

LVAIC Cross Registration Form for Employees and Spouses

• LVAIC Cross Registration Form

Mortgage Incentive Program

• Home Buying Program Brochure
• Mortgage Payment Form
• Promissory Note

Personal Information Changes

(changes in name, address, phone number, emergency contact, or marital status)

• Personal Information Change Form (Docusign Form)
• OneCard Maintenance Form (Use for name changes on OneCard)

Prescription Plan Forms

• Express Scripts Mail Order Form
• Express Scripts Request a New Prescription Form
• Express Scripts Coordination of Benefits/Direct Claim Form

Short Term Disability Plan Forms

• Short Term Disability Claims Procedure
• Short Term Disability Employee Checklist
• Healthcare Provider's Release to Return to Work

Tuition Cash Grant

• Tuition Cash Grant Application (pdf)
• Tuition Cash Grant Application via DocuSign 
• Tuition Cash Grant Fact Sheet (pdf)
• Statement of Dependency Form (pdf)

Vision Plan Forms

• Davis Vision Claim Form

• Voya Employee Benefits Resource Center

Employee Relations Forms

Accommodation Request

• Request for Reasonable Accommodation via the Accommodate system (Includes request for parking accommodation)
• Medical Information Request and Verification Form
• Accommodate system login page

Flextime Guidelines

• Flextime Guidelines document

Employment Forms

Employment Applications (apply for positions through our online system)

• Online Application System

Employment Eligibility Verification (I-9)

• I-9 Form

Leaving Lehigh Forms

Staff Separation Forms

• Request for Reference And Release
• Employee's Separation Information Sheet
• Supervisor's Separation Plan Checklist
• Personnel Information Change Form (Docusign)

Exit Interview Questionnaires

• Employees Transferring Within Lehigh
• Employees Leaving Lehigh

Recognition and Reward Forms

Spot Bonus Award

• Nomination Form (word)

Tradition of Excellence Award

• Tradition of Excellence Nomination Form (pdf)

Staff Compensation Forms

Extra Duty Compensation

• Extra Duty Compensation Request Form (login required)

On-Campus Consulting/Additional Compensation for Exempt Employees

• On-Campus Consulting/Additional Compensation for Exempt Employees Request Form (login required)

Position Descriptions

• How to access your position description

Request for Deferred Pay Exception

• Staff Request to Abstain from Deferred Pay Program

Temporary Bonus Request

• Temporary Bonus Request Form (login required)

Wellness Forms

BeWell 

• Lehigh University's BeWell platform is designed to support employees in their journey towards holistic wellness, encompassing physical, mental, and emotional health. 

CAREER ENRICHMENT and Performance Forms

BEST Program

• BEST Program Registration Form (word)
• BEST Program Registration Form (pdf)

Performance Management

• Read about the Performance Management Process

Career Enrichment @ Lehigh (CE@L) Programs

• Learn about Career Enrichment @ Lehigh
• Register for CE@L Programs
• View the CE@L Calendar
• Download the Career Enrichment Playbook

Workplace Posters - Federal and State Labor Laws

Federal Workplace Labor Law Posters

• Equal Employment Opportunity
• Fair Labor Standards Act
• Family Medical Leave Act
• Government Contracts
• OSHA Job Safety and Health
• Polygraph Protection
• Uniformed Services Employment Rights

• Child Labor Laws (Employment of Minors)
• Equal Pay Law
• Human Relations Act
• Minimum Wage Law
• Unemployment Compensation Notice