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The University of Scranton: Human Resources: Forms


November is Open Enrollment

The University of Scranton’s 2022 Open Enrollment Period will be held November 3, 2021 through November 30, 2021.  The purpose of Open Enrollment is to allow plan participants to make changes to their health plan election (medical, prescription, dental, and vision).  Changes during the Open Enrollment Period may include adding or deleting dependents from the plan, moving from one plan type to another or electing to opt in or out of the plan. 

If you do not wish to make a change to your health plan or opt-out election, you will automatically retain your present coverage.  Benefit choices made during the Open Enrollment Period for an employee or a dependent will take effect on January 1, 2022; provided the eligibility requirements are met, the participant is covered under the Plan, and all enrollment requirements are met. 

All benefit enrollment/change forms must be returned to the Office of Human Resources by the close of the business day on November 30, 2021.

Time Away From Work

Life Insurance Benefits

Tuition Remission

Information Changes

*** Only complete the forms that pertain to your current benefit coverage ***

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:

Change of Information Packets:

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

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.

Performance Management

The following information is for managers, supervisors and employees, to assist with the Performance Appraisal process. 

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