Tuition Waiver

2011 Tuition Waiver (AKA Session Application) Due Dates

Winter Session - October 25, 2011
Spring Semester 2012 - November 7, 2011

• At Millersville
  • Initial Application for Employees (PDF)
  • Initial Application for Spouse or Child - Page 1 of 2 (PDF)
  • Initial Application for Spouse or Child - Page 2 of 2 (PDF)
  • Tuition Waiver (a.k.a. Session Application) (PDF)
• At Other PASSHE Universities
  • Managers Waiver for Manager/Spouse/Domestic Partner/Dependents (PDF)
  • Faculty Waiver for Faculty Member/Spouse/Domestic Partner/Dependents (PDF)

Beneficiary Forms

• Prudential Beneficiary Form (PDF)
  To change your beneficiary(ies) for your group life insurance.  Prudential can be reached at 800-893-7316
• PSERS Beneficiary Nomination Form (PDF)
  Beneficiary form for employees enrolled in the Public School Employees Retirement System
• SERS402 Beneficiary Form (PDF)
  Beneficiary form for employees enrolled in the State Employees’ Retirement System
• TIAA-CREF Beneficiary Form (PDF)
  Beneficiary form for employees enrolled in TIAA-CREF retirement plan)Group Life Insurance
• VGLIP Enrollment Form (PDF)
• VGLIP Beneficiary Change Form (PDF)
  If you are enrolled in the Voluntary Group Life Insurance, you may use this form to update your beneficiaries. Complete only the Employee Section and the Beneficiary Section. Sign and date the form, and return it to Human Resources.
• VGLIP Insurance Change Form (PDF)

HealthCare – PASSHE Group  (Managers, Faculty, Coaches, Nurses, Police)

• Adult Child Attestation Form (PDF)
• Highmark Blue Shield Claim Form (PDF)
• Medco Reimbursement Claim_Form (PDF)
• Medco Mail Order Prescription Form (PDF)
• NVA Non-Participating Providers Claim Form & Instructions (PDF)
• PASSHE Enrollment-Change Form (PDF)
• Pennsylvania Faculty Benefits – Faculty only
  use this link to obtain claim forms for Faculty Health and Welfare benefits, such as dental, vision, hearing, wellness.
• UCCI Dental Claim Form (PDF)

HealthCare – PEBTF Group  (AFSCME, State University Administrators, Physicians)

• Highmark Blue Shield Claim Form (PDF)
• Medco Reimbursement Claim Form (PDF)
• Medco Mail Order Prescription Form (PDF)
• NVA Non-Participating Providers Claim Form & Instructions (PDF)
• PEBTF Adult Child Attestation Form (PDF)
• PEBTF Employee Enrollment/Change Form (PDF)
• UCCI Dental Claim Form (PDF)

Other

• Emergency Contact Information (pdf)
• Salary Reduction Agreement (PDF)  For Tax Sheltered Annuity Program
• Pennsylvania Department of Health - (Birth Certificates, etc.)  Click Here
• Social Security Card Application - Click Here (specific instructions given as to how to submit your application)