UACES Facebook Employee Benefits Templates
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Templates - Employee: Benefits

Cafeteria Plan: Dependent Care Reimbursement and/or Health Care Reimbursement Request - UMR Flexible Spending Reimbursement Form (PDF)

View Policy: CESP 8-21

EBEN-103: Catastrophic Leave Bank Program Donor Application Form (PDF)

View Policy: CESP 7-8

EBEN-105: Dental Enrollment Application; Cancellation of Coverage; Add/Changes to Coverage (PDF)

View Policy: CESP 8-24

EBEN-106: University of Arkansas Health Insurance Enrollment Application (PDF)

View Policy: CESP 8-2 

EBEN-107: Application for Maternity Leave

View Policy: CESP 7-13

EBEN-108: University of Arkansas Superior Vision Plan Enrollment Application

View Policy: None

EBEN-109: Employee Request - Leave for Study

View Policy: CESP 3-35

EBEN-110: Health Savings Account (HSA) Enrollment Form; (Must be enrolled in the Health Savings Plan)

View Policy: CESP 8-2 

EBEN-112: University of Arkansas Flexible Benefits Plan Enrollment Form (PDF)

View Policy: CESP 8-21

EBEN-226: University of Arkansas Group Benefits Change Form (PDF)

View Policy: None

EBEN-227: University of Arkansas Group Benefits Enrollment Form (PDF)

View Policy: None

EBEN-228: Voluntary Salary Deferral Agreement Form (PDF)

View Policy: None

EBEN-231: Request for Consideration Under the Family and Medical Leave Act

View Policy: UASP 425.1

EBEN-327: Request for Leave

View Policy:  CESP 7-4 and CESP 7-7

EBEN-328: Families First Coronavirus Response Act (FFCRA) Leave Request Form

View Policy: None

EBEN-370: U of A Cooperative Extension Service Catastrophic Leave Bank Program Physician's Certification

View Policy: CESP 7-8

EBEN-371A: U of A Cooperative Extension Service Catastrophic Leave Bank Program Application for Medical Emergency Due to Illness/Injury

View Policy: CESP 7-8

EBEN-371B: U of A Cooperative Extension Service Catastrophic Leave Bank Program Application for Medical Extension Request

View Policy: CESP 7-8

EBEN-371C: U of A Cooperative Extension Service Catastrophic Leave Bank Program Application for Maternity Purposes

View Policy: CESP 7-8

PMGS 17-A Employee Request for Registration Fee Discount

PMGS 17-B Request for Registration Fee Discount for Spouse

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