Forms
Benefit forms need to be completed when a benefit eligible staff or faculty member changes address, marital status, and/or benefit plan enrollment. These forms need to be completed and returned to the Human Resources office within 30 days of the qualifying event and/or status change.
- Qualifying Events: A change in your situation — like getting married, having a baby, or losing health coverage — that can allow benefit plan changes outside the yearly Open Enrollment Period
- Verifying dependents: When enrolling a spouse or child (or changing a spouse or child’s enrollment) in University Benefits, documentation demonstrating the current spousal or child relationship may be required
Payroll Change Form:
- Federal Withholding W-4
- Local Residency Tax Certification
- Direct Deposit Form
- Time Sheet for Special Compensation
Change of Information Packets:
- Staff/Faculty enrolled in Benefits
- Staff/Faculty not enrolled in Benefits
- Beneficiary Change
Additional Contribution to Retirement Plan Forms
If you are currently enrolled in the voluntary 403(b) contribution plan, you may change your contribution amount by completing the form for your provider.
If you are not currently enrolled in the voluntary 403(b) contribution plan, please contact the Office of Human Resources at (570) 941-7767.
Please submit the completed Salary Reduction Agreement to the Office of Human Resources. If you would like to maximize your contribution or you have questions, please contact BethAnn McCartney, Benefits Manager, at (570) 941-7767
Please Note: Benefit forms need to be completed when a staff or full-time faculty member changes address, marital status, and/or benefit plan enrollment. All forms need to be completed and returned to the Human Resources office within 30 days of the event and/or status change.
Time Away From Work
Dental Schedule of Benefits
Employee Assistance Program
Flexible Spending Account
- Flexible Spending Enrollment Form
- Flexible Spending Account Brochure
- Flexible Spending Account Eligible Expenses
- FSA Reimbursement Account Claim Form
Life Insurance Benefits
- Basic Life Beneficiary Form
- Voluntary Life Beneficiary Form
- Term Life Enrollment/Change Form
- Cigna Voluntary Life Insurance Brochure
Medical Outlines of Coverage and Health information
- Highmark Enrollment Form
- HMO Plus Outline of Coverage
- PPO Blue Outline of Coverage
- Classic Blue (Traditional) Outline of Coverage
Summary of Benefit Coverage is available at Compliance Corner
Swift MD
Pharmacy Information
Vision Schedule of Benefits
Tuition Remission
The following information is for Graduate Assistants and Work-Study Students to complete the employment process. All forms are available in the Office of Human Resources.
Graduate Assistant Packet
Work-Study Student Packet
The Form I-9 and Direct Deposit form must be completed in the presence of a University of Scranton Human Resource or Payroll staff member. Proper identification required.
The following information is for managers, supervisors and employees, to assist with the Performance Appraisal process.
Human Resources
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Office of Human Resources
St. Thomas Hall, Suite 100
The University of Scranton
Scranton, PA 18510-4633
Phone: 570-941-7767
Fax: 570-941-4636
Contact Information
Office of Human Resources
St. Thomas Hall, Suite 100
The University of Scranton
Scranton, PA 18510-4633
Phone: 570-941-7767
Fax: 570-941-4636
To Report Suspected Child Abuse:
Call CHILDLINE: (800)-932-0313