Benefits Forms
Health Related Forms
Health Enrollment Form (July 2011)Extended Coverage Enrollment Form (COBRA)
Qualifying Event Notice
Anthem Claim Form
Anthem Blue View Vision Out-of-Network Claim Form (for COVA Care Members)
Flexible Spending Account Reimbursement Form
MyFBMC Visa Card FAQs
DHRM Flexible Reimbursement Account FAQs
Once you enroll in a Medical FRA, MyFBMC Visa cards will be mailed to your home address automatically
More Health and Flexible Benefits Forms (DHRM)
Proof of Eligibilty
Retirement Related Forms
Retirement and Life Insurance Forms (VRS)Faculty Retirement Transition Leave Program: Election Form
Faculty Retirement Transition Leave Program: General Release and Covenant Not to Sue form
GMU 403(b) Salary Reduction Agreement
GMU 457 Payroll Authorization Form
457 Plan Participant Enrollment Form
New One-Time Deferral Forms
Family and Medical Leave Act (FMLA) Forms
FMLA Leave Request FormFMLA Leave Supplement Form
FMLA Certification Form
FMLA Designation Form
Extended Leave Request (Supervisor Notification)
Return to Work Form
Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave
Certification of Qualifying Exigency for Military Family Leave
Virginia Sickness and Disability Program (VSDP) Forms
Extended Absence Leave Supplement FormExtended Leave Request (Supervisor Notification)
VSDP Short Term Disability Return to Work
Workers' Compensation Protocol
Workers' Compensation Return to Work FormTransitional Duty Plan Form
Panel Physician Selection Form
First Report of Accident Form - pdf (16Kb)
VA DMV Disabled Parking Application - pdf (23Kb)
VSDP Handbook - pdf (196Kb)
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