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Office of Human Resources

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Forms - Benefit Forms

Claim Forms
Advantage/Flexible Spending Account Reimbursement (CBA/EPBA) (PDF)
Dental Claim (CIGNA) (PDF)
Health Plan Claim (CIGNA) (PDF)
Vision Claim (CIGNA) (PDF)

Advantage / Flexible Spending Account Forms
Additional Card Request (PDF)

Leave, Retirement and Salary Reduction Programs
Family and Medical Leave (PDF)
Incentive Retirement (PDF)  Policy (PDF)
Partial/Phased Retirement Program (PPRP) Application (PDF)  Policy (PDF)
Salary Reduction Agreement for Faculty and Salaried Employees (PDF)
Salary Reduction Agreement for Hourly Paid Employees (PDF)

Tuition Waivers
Tuition Waiver – Employee (PDF)
Tuition Waiver – Employee’s Dependent (PDF)

Other Benefits Forms
Authorization for the Use and/or Disclosure of Protected Health Information (HIPPA) (PDF)
Biometrics Screenings – Physician (PDF)
Worker’s Compensation Incident Report

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Blue Sky Human Resources Initiatives

Contact Information

Office of Human Resources
5717 Corbett Hall
Orono, ME 04469
Phone: (207)581-1581E-mail:
The University of Maine
Orono, Maine 04469
A Member of the University of Maine System