Human Resources

The following forms are in PDF format. If you do not have Acrobat Reader, please download your free copy by clicking here.

Benefit Forms

• ADA Dental Claim Form (pdf)
• Member Medical Claim Form (pdf)
• Health Insurance Claim Form (pdf)
• Prescription Drug Claim Form (pdf)
• PayFlex Health/Dependent Care Claim Form (pdf)
• TIAA-CREF Salary Reduction Agreement (pdf)
• Spelman College Tuition Reimbursement Process (pdf)
• Spelman College Tuition Assistance Request Form (pdf)
• Spelman College Request for Leave of Absence (pdf)

General HR Forms

• Federal Employee's Withholding Allowance Certificate-W-4
• Spelman College Temporary Requisition (pdf)
• State of GA Employee's Withholding Allowance Certificate - G-4 (pdf)
• Spelman Vacation Request Form (pdf)
• Staff Supplemental Pay Request Form (pdf)

HIPPA Privacy Policies and Forms

• HIPPA Privacy Policy for Fully Insured Plans (pdf)
• Privacy Notice for Health FSA (pdf)
• HIPAA Procedures and Uses & Disclosures for Health FSA (pdf)
• HIPAA Authorization Procedures and Form (pdf)
• Revocation of Authorization to Release Protected Health Information (pdf)
• Mitigation after Improper Protected Health Information (pdf)
• HIPPA Privacy Complaint Form (pdf)

Employment Forms

• Personnel Action Form (pdf)
• I-9 - Employment Eligibility Verification (pdf)
• W-4 - Employee’s Withholding Allowance Certificate (pdf)
• Employee Data Profile Sheet (pdf)
• Spelman College Employment Application (pdf)
• Internal Career Opportunity Application (pdf)
• Georgia Withholdings G-4 (pdf)

Payroll Forms

• Direct Deposit Form (pdf)
• General College Student Payroll Action Form (pdf)
• Payroll Advance Form (pdf)

Performance Management Forms
The following forms are in MS Word format.

• Performance Feedback Form (doc)
• Feedback Framework Worksheet (doc)
• Performance Coaching Form (doc)
• Performance Planning & Evaluation Form (doc)
• Supervisor's Guide to Performance Management (pdf)