Forms & Policies
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Benefit Forms
| Benefit Claim Forms | |
| Form Name | Description |
|---|---|
| Assure Card Claim Form |
Submit this form for prescription drug claims. More info… |
| Healthcare Expenses Statement | This form is used for extended health claims (including eye exams) covered under your plan. More info… |
| Dental Claim Form | Submit this form for dental claims. More info… |
| Visioncare Claim Form | Submit this form to claim the costs of purchasing glasses or contacts. More info… |
| Out of Country Claim Form | Submit this and the out of country authorization and release form to claim out-of-country medical expenses. More info… |
| Out of Country Authorization and Release Form | Submit this and the out of country claim form to claim out-of-country medical expenses. More info… |
| Benefit Application and Change Forms | |
| Form Name | Description |
|---|---|
| Beneficiary Nomination Form | Change your beneficiaries for Group Life Insurance. More info… |
| Evidence of Insurability | This form is used in addition to the Group Coverage Change form when you are a late applicant for health, dental or optional life insurance, or when you want to increase your optional life insurance. More info… |
| Group Coverage Change Form | Enrol in or change benefits information – includes health & dental, reinstatement or refusal of benefits, optional life insurance, beneficiary changes and name changes. More info… |
| Optional Life Insurance – Trustee Appointment Form | Assign a trustee for optional life insurance when your beneficiary is a minor or lacks legal capacity. More info… |
| Tuition Benefits | |
| Form Name | Description |
|---|---|
| Free Tuition Application | Submit this form to apply for free tuition. See your benefits package for eligibility. More info… |
| Contract Instructor Tuition Waiver | Application to waiver tuition fees for contract instructors. More info… |
Career Development Forms
| Form Name | Description |
|---|---|
| Career Development Fund Application Form | The Career Development Fund is available to assist employees who wish to pursue training associated with career development objectives. More info… |
Miscellaneous Forms
| Form Name | Description |
|---|---|
| CUASA Professional Expense Reimbursement Form | CUASA members are to complete this form and submit to their Dean’s Office for reimbursement of professional expenses More info… |
| Monthly Leave Report | This leave report is to be filled out monthly and submitted to your manager (CUPE 2424, Administrative-Technical Exempt, Administrative Management, and Executive Groups) |
| Monthly Overtime Report | Overtime worked by CUPE 2424 and Administrative technical exempt employees must be pre-approved and authorized using this form. More info… |
| Name Change Request Form | Submit this form along with two pieces of identification to change your name with Carleton University. |
Payroll Forms
| Form Name | Description |
|---|---|
| Confidentiality Agreement | Submit this form to human resources when you are setup as a new employee. More info… |
| Mandatory Training | Submit this form to human resources when you are setup as a new employee. More info… |
| Personal Information Form | Submit this form to human resources when you are setup as a new employee. More info… |
| TD1 – Federal | Submit this form to human resources when you are setup as a new employee. More info… |
| TD1ON – Provincial | Submit this form to human resources when you are setup as a new employee. More info… |
| Health and Safety Employee Orientation Manual | Submit this form to human resources when you are setup as a new employee. More info… |
Pension Forms
| Form Name | Description |
|---|---|
 Letter of Retirement Template |
Letter template to confirm retirement to management. |
| Pension Beneficiary Change Form | Update/change your Pension Beneficiaries. Contact the Pension Officer if you require assistance. |
| Retirement Plan – Optional Enrolment Form | Submit this form to Pension Services if you are an eligible employee under the age of 30. Contact Pension Services for more information. |
| Request for Foreign Currency Benefit Payment by Wire or Draft | Deposit options for retirees living abroad. |
| Transfer of Pension Funds to a Registered Pension Plan | Used when transferring out of the Carleton University Retirement Plan to your new employer. Contact the Pension Officer for more information. |
| Transfer of Pension Funds to A Locked-In Retirement Account | Used when transferring out of the Carleton University Retirement Plan to a LIRA. Contact the Pension Officer for more information. |
| T2151 – Direct Transfer of a Single Amount under Subsection 147(19) or Section 147.3 | Government document to transfer out your Carleton University Retirement Plan. |
| U.S. Direct Deposit Request Form | Direct deposit for US Residents. |