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Forms List
All of the forms listed below are either in PDF or Microsoft Word format unless otherwise noted. The PDF format requires the free Adobe Reader application be installed. The reader can be downloaded and installed from: http://www.adobe.com/products/acrobat/readstep2.html. The Word format requires that Microsoft Word be installed on the local machine.
As an alternative, a list of only Faculty and Academic Staff Forms or Support Staff forms is available for easily selecting a form.
Academic Position Request - Fixed Term Pre-populated Forms System Academic Hiring Report Academic Position Request - Tenure System / Continuing Pre-populated Forms System Academic Specialist Suggested Orientation Checklist (link) Appointment AHR Forms Application Conflict of Interest in Employment PDF Word Dubai Faculty/Academic Staff PDF Word Dubai Support Staff PDF Word Exposure to Health Risks / Physical Demands Form PDF Word Fixed Term Faculty / Academic Staff Appointment / Reappointment Memorandum PDF HP Faculty Appointment / Reappointment Memorandum PDF Immigration and Naturalization Service I-9 Form (info page and form link) Load and Salary Form for Summer School Pre-populated Forms System Memorandum of Understanding PDF Multiple Appointment Memorandum PDF New Hiring Form Social Security Directions Word Pre-Employment Test Consent PDF Specialist Position Description PDF Staffing Request / Reclassification Form PDF Word
Benefits
Dental Aetna Dentist Nomination Form PDF Word
FSA Meritain Health - Reimbursement Request Instructions PDF Word Meritain Health - Reimbursement Request Form PDF Word Meritain Health - Direct Deposit PDF Word Meritain Health - HCSA Debit Card Substantiation Form PDF Word
Health Care Affidavit of Dependency PDF Word Hardship Application PDF Loss of Previous Coverage PDF Word
Life / Accident Insurance Beneficiary Designation PDF Word
Long Term Disability Return to Work Verification PDF Word
Other Eligible Individual (OEI) Other Eligible Individual Form PDF Taxation of Other Eligible Individual PDF
Retirement Application for Retirement for Faculty / Academic Staff PDF Word Application for Retirement for University Support Staff PDF Word
Student Health Insurance
Application for Supplemental Repatriation/Medical Evacuation Insurance PDF *Student Health Insurance Plan Continuation of Coverage PDF (*Please note this form is for students whose health coverage is ending with Aetna and are no longer enrolled in classes.) Student Health Insurance Visiting Scholars Enrollment PDF ____________________________________________
Fellowship/Visiting Scholars Student Health Insurance Request Form: (to be used by DEPARTMENTS ONLY to enroll fellows/visiting scholars in the Student Health Insurance Plan) PDF
Tuition Assistance Educational Assistance Program Application PDF Word
Workers' Compensation Authorization to Invoice MSU PDF Word Authorization to Invoice MSU for Employees not in the Lansing Area PDF Word Injury Absence Report PDF Word Intent to Treat PDF Word Medical Travel Reimbursement Request PDF Word Report of Claimed Occupational Injury or Illness PDF Word
Time off / Leave Programs
Request for Time Off PDF Word Information for Leave of Absence - other than sabbatical (Faculty / Academic Staff) PDF Leave of Absence (Faculty/Academic Staff) PDF FMLA Forms Sabbatical Leave Information (Faculty / Academic Staff) PDF
Performance Review & Development
Annual Evaluation for Chairpersons / Directors PDF Employee Self-Review Worksheet PDF Word Evaluation Guidelines for Academic Administrators PDF Executive Management Performance Development Program PDF Word HP-D Health Programs Recommendation for Promotion PDF HP-C Health Programs Recommendation for Reappointment PDF Interim Evaluation (APA, APSA) PDF Word Notice of Non-Academic Disciplinary Action PDF Word Notice of Suspension Pending Investigation PDF Word Observed Behavior - Reasonable Cause Record PDF Word Performance Development Program PDF Word Performance Development Program II PDF Word Performance Improvement Plan PDF Word Probationary Evaluation PDF Word Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status ALL PAGES (single PDF) Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 1 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 2 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 3 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 4 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 5 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 6 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 7 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 8 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 9 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 10 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 11 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 12 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 13 PDF Recommendation for Reappointment, Promotion or Tenure Action (Tenure System Only) - Entire Document PDF Word
Professional Development / Training
Educational Assistance Program Application PDF Word ETC-CT Application PDF Word Foundations Application PDF Word Front Desk Application PDF Word Leadership from the Inside Application PDF Word Leading Edge Application PDF Word
Pay, Rewards & Recognition
Additional Payments PDF Clerical Technical Recognition Award PDF Word Direct Deposit (link) Outside Work for Pay / Overload Pay PDF Special Payment Authorization PDF W-4 Forms (Federal, State, City) (link)
Reappointment, Promotion & Reclassification
HP-D Health Programs Recommendation for Promotion PDF HP-C Health Programs Recommendation for Reappointment PDF Recommendation for Reappointment, Promotion or Tenure Action (Tenure System Only) - Entire Document PDF Word Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status ALL PAGES (single PDF) Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 1 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 2 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 3 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 4 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 5 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 6 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 7 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 8 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 9 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 10 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 11 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 12 PDF Academic Specialist Recommendation for Reappointment, Promotion or Award of Continuing Appointment Status - Page 13 PDF
Acknowledgment of Receipt of Educational Materials on Alcohol and Substance Abuse for Operators of Commercial Motor Vehicles PDF Word Controlled Substances Test Results Notification PDF Word Drug Testing Procedures Driver Fact Sheet PDF Word Non-Union Regular Support Staff Grievance Procedure Form PDF Word Notice of Non-Academic Disciplinary Action Form PDF Word Notice of Suspension Pending Investigation PDF Word Observed Behavior - Reasonable Cause Record PDF Word Pre-Employment Testing Consent PDF Request for Time Off PDF Word
Termination & Separation
Adjunct / Clinical Emeritus Status PDF Affidavit of Termination of Domestic Partnership PDF Termination / Separation Checklist PDF
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