Human Resources
Waller Hall, First Floor
Willamette University
900 State Street
Salem, Oregon 97301
503-370-6210 voice
503-370-6570 fax
Benefits - View and Print Forms:
Welcome. This is your "One-stop" location from which you can view and print any necessary form related to your benefits. If you need a form or other information that is not provided here, please contact your benefit administrator, Suzie Torre-Cross, GBA at 503.370.6210 ext. 4043 or via email at storre@willamette.edu. Thank you.
Checklist for New Employees
- New Employee Benefits Checklist
- Regence Blue Cross/Blue Shield: Short-term, Interim Medical Insurance Link
Medical/Dental and Flexible Spending Enrollment/Change Forms
Claim Submission Forms
- Medical/Dental/Vision
- Prescription
- PPS Mail Order prescription refill
- Health Care or Dependent Care Expenses (FSA)
Basic Life, Optional Life, AD&D, and Long-Term Disability (LTD)
- Life Insurance Beneficiary Designation Form
- Optional Life Insurance Enrollment Form
- Evidence of Insurability (for Optional Life Insurance)
- Verification of Prior Coverage (LTD)
Retirement
Tuition Remission Benefit Forms
- Dependent Application Form
- Spouse/Domestic Partner Application Form
- Faculty and Staff Application Form
Facutly and Staff Graduate Tuition Benefit Taxability FAQ
Spouse/Domestic Partner Affidavit
On-the-job Injury
- Incident Only Report Form
- First Report of Injury/Illness Report (Form 801)
- Physician Claim form for Worker's Compensation
- Work Release Form (to be completed by physician)
Family/Medical Leaves
- Oregon Family Leave Law (OFLA) Information
- Family Medical Leave Law (FMLA) Information
- Request for Family Leave Form
- Medical Certification Form - Required If:
1. You are taking leave for your own serious health condition
2. You are taking leave to care for your family member
3. You are taking time off to care for a servicemember
Shared Leave Program