Forms

Information Changes


Benefit Forms

Please Note:  A Highmark Enrollment form must 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.

Add a Spouse:

  • In addition to the Highmark Enrollment form, please attach a copy of marriage certificate.
  • If a spouse will also maintain other primary insurance, please provide a copy of both primary insurance card and insurance information (effective date, medical, vision and/ or dental coverage).
  • If a spouse no longer has primary insurance, please provide termination of coverage letter.

Add a Dependent

  • In addition to the Highmark Enrollment form, please attach a copy of birth certificate and provide social security number.
  • For a newborn, if you do not have the Social Security number, return the Benefit Form and provide HR with the Social Security number when issued.

Delete a Spouse

  • In addition to the Highmark Enrollment form, please attach a copy of the divorce decree.
  • Please attach a copy of QDRO, if applicable.

Add Children/Stepchildren

  • In addition to the Highmark Enrollment form, please attach a copy of the previous year’s tax return indicating reported dependents.

Highmark Enrollment Form

 

Graduate Assistants & Work-Study Students

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.

Eligible Non-Employee Affiliates

There are occasions when the University of Scranton wishes to appoint individuals to perform services that are provided without remuneration and for the benefit of the institution, or pursuant to an exchange program or grant.  These individuals will be designated as non-employees for purposes of the workforce.  However, these non-employees may be granted access to university property, facilities or information systems as necessary for the services they perform.   

To assure that the university is aware of and maintains control of the services and access privileges granted to such individuals, departments wishing to appoint a non-employee will appoint non-employees as outlined in this policy.  Unless persons are appointed in accordance with this policy, they will not be granted access to any restricted property, facilities and/or the information systems.

Eligible Non-Employee Affiliate Form

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