Maytum Hall administration building on the Fredonia campus.


The following forms are in Microsoft Word or PDF format and can be downloaded and printed for your convenience. Download free Adobe Acrobat Reader to view forms in Portable Document Format (PDF).
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Benefit Forms


Health Insurance

NYS Health Insurance Transaction Form (PS-404) - PDF
NYS Health Insurance Opt-Out Attestation (PS-409) - PDF
NYS Health Insurance Domestic Partner Packet (PS-425 series) - PDF
Pre-Tax Contribution Program Fact Sheet - PDF


Retirement Program History & Election Forms - PDF
Retirement Consultation Verification - Word
Salary Reduction Agreement - PDF

Employees' Retirement System (ERS):

  • ERS Membership Application - PDF
  • ERS Designation of Beneficiary Form - PDF

Teachers Retirement System (TRS):

  • TRS Membership Application - PDF

Optional Retirement Program (ORP):

  • ORP Enrollment Instructions - PDF
  • ORP to ERS System Determination Form (ORP-4) - PDF

Other Benefits

UUP Waiver Memo and Form 2019 - PDF
Breast Cancer Screening Leave - PDF
Group Long Term Disability Insurance Program - PDF
Prostate Cancer Screening Leave - PDF
SUNY 403(b) Salary Reduction Agreement - PDF

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Classification & Compensation

Application for Change in Title or Salary - PDF
Existing Position Description - PDF
New Position Description - PDF

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Employment & Leaves

Address/Telephone/Name Change Form - PDF
Agility Waiver and campus map for University Police 1 Applicants
Employee Action Form - Word | PDF
Employment Eligibility Verification (I-9) - PDF
Honorarium - XLS
I-9 Fillable Form - PDF
Information Release Form - PDF
Leave Donation To Individual - PDF
Leave Donation To Sick Leave Bank - PDF
Leave of Absence (Family or Medical) *Employees must contact Human Resources for consultation*
Family & Medical Leave Request Form - PDF
Medical Certification Forms - WH-380-E, WH-380-F, WH-381, WH-382
FMLA Facts - WHD-1420, WHD-FS28
Request for Approval of Professional Appointment - PDF
Request for Prior Service Credit - Academic - Word | PDF
Request for Prior Service Credit - Non-teaching Professional - Word| PDF
Sabbatical Leave Request Form
Verification - Start of Work (Started) - Word | PDF
Verification - Start of Work (Returned) - Word | PDF

Classified Staff: If you have been permanently transferred appointed or reinstated to a new agency and your name is on an interdepartmental promotion eligible list(s), use this form (S-211.1) to request to have your name placed on your new agency’s departmental portion of the interdepartmental promotion eligible list(s)

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Faculty and Professional Searches

Faculty & Professional Search Guidelines
Search Committee Interview Exchange Instructions
Search Procedure Workflow

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Handbook on Appointments, Reappointments, and Promotions (HARP) for UUP

Appendix A: Department Personnel Committee (DPC) Ballot - Word | PDF
Appendix B: Academic Personnel Committee (APC) Ballot - Word | PDF
Appendix C: Conflict of Interest (COI) Form - Word | PDF
Appendix D: Suggestions for Preparing a Dossier for Reappointment, Continuing Appointment, or Promotion - PDF
Appendix E: Performance Program Form - Click Here
Appendix F: Performance Evaluation Form - Click Here
Appendix G: Request to Pause the Tenure Clock - Word | PDF
Appendix H: Request to Pause the Permanent Appointment Clock - Word | PDF
Appendix I: Emeritus Application
Appendix J: Request for Prior Service Credit - Academic Position - Word | PDF
Appendix K: Request for Prior Service Credit - Non-Teaching Professional Position - Word| PDF
Appendix L: Classroom Observation Pre-Visit Questionnaire - Click Here
Appendix M: Classroom Observation Feedback Form - Click Here
Appendix N: Classroom Observation Post-Visit Questionnaire - Click Here

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Direct Deposit of Salary Enrollment/Change Form - PDF
Dual Employment Form, UP-8 - Word | PDF
Federal Employee Withholding - Form W-4 - PDF
New York State Employee's Withholding Allowance Certificate (IT-2104) - PDF

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Performance Program & Performance Evaluation

PP/PE Forms are located HERE

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VRWS - Voluntary Reduction in Work Schedule

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Workers' Compensation

Report of Accident or Injury (other than a motor vehicle accident) - PDF

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