Refer to unclassified transactions for personnel and payroll forms. Refer to summary of benefits for unclassified faculty and staff for benefits forms.
| FORMS by Name | Dated | Instructions or Information |
Versions | |||
|---|---|---|---|---|---|---|
| Accident/Injury Report (PER-17) (Workers' Compensation) | 02/2010 | PPM 4820.100 | RTF | Word | ||
| Additional Pay | 01/2007 | Faculty Awards PPM 4650.110 |
RTF | Word | ||
| Additional Pay Checklist #1 | 4/2001 | Faculty Awards PPM 4650.110 |
RTF | Word | ||
| Additional Pay Checklist #2 | 04/2005 | Faculty Awards PPM 4650.110 |
RTF | Word | ||
| Administrative Leave Reporting | 6/2003 | PPM 4860 | RTF | Word | ||
| Advance Leave Agreement PER-60 | 10/2009 | Leave Advancement Policy | RTF | Word | ||
| Affiliated Person or Emeritus Faculty Form (PER-22) | 7/2009 | Included | RTF | Word | ||
| Agency Payroll Deduction Authorization | 5/2007 | Agency Payroll Deductions | RTF | Word | ||
| Agreement of Understanding for Overlapping Appointment (PER-28) | 10/2004 | Military Service Policy | RTF | Word | ||
| Agreement for Reimbursement of Moving Expenses(DA-22) | 11/1998 | Moving Expenses | RTF | Word | ||
| Application for Tuition Assistance | 2011/2012 | |||||
| Application for Tuition Assistance - Dependents/Spouses | 2012/2013 | Dependent/spouse grant | ||||
| Appointment Form (PER-38) | 03/2011 | 4650.090 | RTF | Word | ||
| Authorization to Release Information | 10/2004 | PPM 4010 | RTF | Word | ||
| Background Check Request Form (PER-59) | 04/2010 | Background Checks | RTF | Word | ||
| Beneficiary Designation (KPERS-7/99) | 07/2006 | PPM 4820.60 | ||||
| Change or Separation Form (PER-39) | 12/2006 | Unclassified | RTF | Word | ||
| Designation of Beneficiary (KPERS-7/99) | 07/2006 | PPM 4820.60 | ||||
| Direct Deposit of Employee Pay (PER-58) | 12/2010 | Instructions Information |
RTF | Word | ||
| Documentation of Service for Immediate Participation in Regents Retirement Program (PER-33) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Educational Authorization Form (PER-25) | 5/1998 | PPM 4870.20 | RTF | Word | ||
| Emeritus Faculty or KSU Affiliated Employee Form (PER-22) | 7/2009 | Included | RTF | Word | ||
| Employee Separation Checklist (PER-24) | 06/2011 | Classified Separations Unclassified Separations PPM 4950 |
RTF | Word | ||
| Employment Eligibility Verification (I-9) | 08/2009 | Instructions | ||||
| Exit Interview Letter at Resignation | 06/2007 | PPM 4950 | ||||
| Exit Interview Letter at Retirement | 06/2007 | PPM 4950 | ||||
| Faculty and GTA Spoken English Competency Assessment Sheet (PER-20) | 08/2010 | 4650.075 | RTF | Word | ||
| Flexible Spending Claim Form | 2011 | Flexible Spending Accounts | ||||
| Flexible Spending Account Direct Deposit/E-Mail Notification Form | Flexible Spending Accounts | Word | ||||
| Flexible Spending Account Enrollment/Change Form | 2011 | Flexible Spending Accounts | ||||
| FMLA Certification of Health Care Provider for Employee's Serious Health Condition | FMLA Dept. of Labor | |||||
| FMLA Certification of Health Care Provider for Family Member's Serious Health Condition | FMLA Dept. of Labor | |||||
| FMLA Notice of Eligibility and Rights & Responsibilities | FMLA Dept. of Labor | |||||
| FMLA Designation Notice | FMLA Dept. of Labor | |||||
| FMLA Certification of Qualifying Exigency For Military Family Leave | FMLA Dept. of Labor | |||||
| FMLA Certification for Serious Injury or Illness of Covered Servicemember -- for Military Family Leave | FMLA Dept. of Labor | |||||
| KSU Foreign National Tax Information Form (PER-15) | 07/2007 | Visa Classifications | RTF | Word | ||
| Health Care Selection Form | 06/2003 | Health Insurance | ||||
| Health Insurance Affidavit of Common Law Marriage | 2012 | Health Insurance | ||||
| Health Insurance Application for Coverage of Handicapped Dependent Child | 2012 | Health Insurance | ||||
| Health Insurance Change Form | 2012 | Health Insurance | ||||
| Health Insurance Communication Form | 2012 | Health Insurance | ||||
| Health Insurance Dependent Grandchild Affidavit | 2012 | Health Insurance | ||||
| Health Insurance Enrollment Form | 2012 | Health Insurance | ||||
| HIPAA- Authorization Form for Release of Medical Information | 2012 | Health Insurance | ||||
| Health Savings Account Enrollment & Change Form | 2012 | Health Insurance | ||||
| HealthyKIDS Application | Information | Online | ||||
| HRIS/PeopleSoft Access Form | Instructions (pdf) HRIS Roles |
RTF | Word | |||
| NEW Online HRIS Access Termination Form | Online | |||||
| Intellectual Property Agreement | Information | RTF | Word | |||
| Investment Agreement - Mandatory Retirement Plan (Kansas Board of Regents) (PER-13) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Investment Agreement - Voluntary Pre-Tax Retirement Plan (PER-19) | 12/2010 | PPM 4810.80 | ||||
| Investment Agreement - Voluntary Roth After-Tax Retirement Plan (PER-19R) | 12/2010 | PPM 4810.80 | ||||
| Kansas Board of Regents Mandatory Retirement Plan Investment Agreement (PER-13) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Kansas Employee's Withholding Allowance Certificate (K-4) | 09/2007 | Information | ||||
| Learning Quest Direct Deposit Change or Enrollment Form | Information | |||||
| Leave Balance Correction Sheet (PER-9) | 5/2001 | Information | RTF | Word | ||
| Leave Record | 05/2012 for FY 2013 |
Instructions | RTF | Word | Excel | |
| Leave Record | 04/2011 for FY 2012 |
Instructions | RTF | Word | Excel | |
| Leave Request-Salaried (Exempt) Faculty and Staff | Instructions | Online | ||||
| Leave-Sabbatical Leave Application Form | Guidelines | Online | ||||
| Life Insurance Beneficiary Designation Form (TEA) | 07/2001 | Included TEA Life Insurance |
||||
| Life Insurance Enrollment Form (TEA) | TEA Life Insurance | |||||
| Life Insurance Request to Change or Cancel Insurance Policy Form (TEA) | TEA Life Insurance | |||||
| Life Insurance Statement of Health (TEA) | TEA Life Insurance | |||||
| Mid Year Base Salary Increase Form (PER-46) | 12/2003 | Included | RTF | Word | ||
| Mileage Reimbursement Form (Workers' Compensation) | Information | RTF | Word | |||
| New Course Data Sheet | 4/2011 | Instructions (PDF) | RTF | Word | ||
| New Employee Orientation Forms Checklist | 11/2001 | PPM 4070 | RTF | Word | ||
| 9 Month Unclassified Summer Transactions (PER-45) | 04/2008 | Instructions | RTF | Word | ||
| Non-Resident Alien Forms | Non-Resident Alien Employment | |||||
| Notification of Retirement (PER-37) | 6/2009 | PPM 4810 | RTF | Word | ||
| Optional Group Life Enrollment Form | Optional Life | |||||
| Optional Group Life Reduction/Cancellation Form | 09/2003 | Optional Life | ||||
| Orientation Forms Checklist | 11/2001 | PPM 4070 | RTF | Word | ||
| Paycheck Stop Payment Request (DA-6P) | 05/2006 | Information | Excel | |||
| Payroll Transfer Form (PER-44) | 04/2009 | Instructions | Excel | |||
| Performance Management Process Form | NEW | Performance Management
Process Instructions |
RTF | Word | ||
| Position Description (Unclassified Professional Positions) (PER-23) | 08/2011 | Instructions Position Descriptions Checklist |
RTF | Word | ||
| Position Data Sheet (PER-36) | 02/2007 | 4650.140 | RTF | Word | ||
| Prescription Claim Form | Prescription Drug Program | |||||
| Report/Labels Request | Reports(Ad hoc) | RTF | Word | |||
| Retirement Notification (PER-37) | 6/2009 | PPM 4810 | RTF | Word | ||
| Retirement Plan Investment Agreement - Mandatory (Kansas Board of Regents) (PER-13) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Retirement Plan Investment Agreement - Voluntary Pre-Tax (PER-19) | 12/2010 | PPM 4810.80 | ||||
| Investment Agreement - Voluntary Roth After-Tax Retirement Plan (PER-19R) | 12/2010 | PPM 4810.80 | ||||
| Shared Leave Donation Form (PER-64D) | 4/2012 | Instructions | RTF | Word | ||
| Shared Leave Request Form (PER-64A&B) | 4/2012 | Instructions | RTF | Word | ||
| Substance Abuse Policy Affirmation Form | 5/2007 | Information | RTF | Word | ||
| Supplemental Pay Form (PER-8) | RTF | Word | ||||
| Tax Clearance Information Form for Candidates and New Hires (DA-2004a) | 05/2004 | Information | ||||
| TEA Life Beneficiary Designation Form | 07/2001 | Included TEA Life Insurance |
||||
| TEA Life Insurance Enrollment Form | TEA Life Insurance | |||||
| TEA Life Insurance Request to Change or Cancel Insurance Policy Form | TEA Life Insurance | |||||
| TEA Life Insurance Statement of Health | TEA Life Insurance | |||||
| Tuition Assistance Application | 2011/2012 | |||||
| Tuition Assistance Application - Dependents/Spouses | 2012/2013 | Dependent/spouse grant | ||||
| Workers' Compensation Accident/Injury Report (PER-17) | 02/2010 | PPM 4820.100 | RTF | Word | ||
| Workers' Compensation Mileage Reimbursement Form | Information | RTF | Word | |||
| W-4 Employee's Withholding Allowance Certificate OR Update online in Employee Self Service |
2012 | Included Information |
||||
| Withholding form Kansas Employee's Withholding Allowance Certificate (K-4) |
09/2007 | Information | ||||
| W-9 Request for Taxpayer Identification Number and Certification | 10/2007 | Included | ||||