An Iowa College in the Liberal Arts Tradition
Forms for Faculty and Staff
The forms listed below are most often requested from the Human Resources Office.
Bank Deposits
Tax Forms
Additional Employment Forms
- Employee Chosen Name Application
- Faculty Parental Leave Request Form
- Instructions for Change Form (.doc)
- Job Description Template (.doc)
- MEP (TIAA Salary Deferral Agreement) Multiple Employer Plan Salary Deferral Agreement
- Minors on Campus Training Workbook
- Moving Expense Form for New Employees
- Personal Information Change Form (Type directly on form & print)
- Request to Hire Form (Word doc)
- Staff Parental Leave Request Form
- Temporary Employee Offer Worksheet
- TIAA Rollover Form (to roll monies into your Luther account)
- 2021-22 Part-Time Tuition Credit Application (faculty/staff taking a class)
- Volunteer Agreement Form
- Remote Work (Regular) Form
- Remote Work (Ad Hoc) Form
- Workers Compensation Reporting Worksheet
Health Care Forms
- Delta Dental Enrollment/Change Form
- Flexible Benefit Dependent Care Reimbursement Form
- Flexible Benefit Health and Dependent Care Change Form
- Flexible Benefit Medical Care Reimbursement Form
- Flexible Benefit 2022 Enrollment Form
- HSA Account Authorization
- HSA Payroll Deduction Authorization
- Health Claim Submission Form - UMR
- Health Insurance Enrollment Form for 2022 (pdf)
- Pharmacy Mail Order Form
- Prescription Drug Reimbursement Claim Form
- 2022 Wellness Checkup Form
Related Documents
- Job Description Template (187 KB Word Document)Job Description template
- 2021-2022 Part-Time Tuition Credit Application (faculty/staff taking a class) (87 KB Word Document)2021-22 Part-time Tuition Credit Application
- Multiple Employer Plan (MEP) Salary Deferral Agreement (95 KB Word Document)doc
- 2022 Iowa W-4 (191 KB PDF Document)
- 2022 Federal Withholding (172 KB PDF Document)
- Remote Work (Regular) Form (March 2022) (53 KB Word Document)Remote Work Policy form for regular remote work
- Remote Work (Ad Hoc) Form (March 2022) (53 KB Word Document)Remote Work Policy form for ad hoc remote work