Benefit Forms

*Some of these forms may require Adobe Acrobat Reader 5.0 or later

403(b) Voluntary Salary Reduction Agreement

403(b) Explanation of Contribution Limits

403(b) Outside Contribution Disclosure Form

457(b) Voluntary Salary Deferral Agreement

Change of Address - CMU

Dental Claim Form - Meritain

Dependent Day Care Flexible Spending Account, Request for Reimbursement

Dependent Day Care Receipt Form

Dependent Day Care W-10 form

Fidelity 403b Custodial Account application (employee contribution)

Fidelity Beneficiary Designation

Fidelity Custodial Account application (university contribution)

FSA Direct Deposit Form

Hartford Evidence of Insurability Form

Health Care Flexible Spending Account, Request for Reimbursement

Maximizing Tax-Deferred Investment Contributions Worksheet

MPSERS Beneficiary Designation

Retirement Vendor Allocation Form-R8.5 (university contribution) for Service Maintenance

Retirement Vendor Allocation Form-R9.5 (university contribution) for Supervisory Technical, hourly Professional Administrative, and Office Professionals

Retirement Vendor Allocation Form-R10 (university contribution) for salaried Professional Administrative, Police (including hourly P&A police sergeants), hourly & salaried Public Broadcasting, Senior Officer, Fixed-Term Faculty, and Regular Faculty

Retirement Vendor Allocation Form-R12 (university contribution) for employees in the 12% Retirement Plan (these employees were hired prior to January 1, 1996 and have continuous employment

Status Change Form

TIAA-CREF 403(b)  Group Supplemental Retirement Annuity enrollment   (employee contribution)

TIAA-CREF 457(b)  Group Supplemental Retirement Annuity enrollment   (employee contribution)

TIAA-CREF Retirement Annuity enrollment form (university contribution) ​​​​​​​​​​​​​​​

Central Michigan University • 1200 S. Franklin St. • Mount Pleasant, Mich. 48859 • 989-774-4000