Tuition Waiver Due Dates - 2013
Tuition Waiver (A.K.A Session Application)
One waiver per period (see form)!

Summer Session I - April 2, 2013
Summer Session II - May 3, 2013
Summer Session III - May 31, 2013

Fall Semester - July 8, 2013

Winter Session - October 22, 2013

Spring 2014 Semester -  November 8, 2013 

• 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

• MetLife (Basic Life Insurance) Call 1-855-972-5433 to change beneficiary information or update personal information
• 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)
• Healthy U Fitness Log (doc)
• 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) (excluding Faculty)
• PASSHE Enrollment-Change Form (PDF)
• Pennsylvania Faculty Health & Welfare Fund (Faculty Only)
• UCCI Dental Claim Form (PDF) (excluding Faculty)

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)