Forms
Health Insurance
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Dental/Vision Insurance
- Dental Claim Form (PDF)
- Dental Claim Form (TXT)
- Dental Claim Form (Back - instructions)(PDF)
- Dental Claim Form (Back - instructions) (TXT)
- Dental/Vision Change Form (PDF)
- Dental/Vision Change Form (TXT)
- Vision Claim Form (PDF)
- Vision Claim Form (TXT)
Section 125
- 125 Health Care Reimbursement (PDF)
- 125 Health Care Reimbursement (DOC)
- 125 Dependent Care Reimbursement (PDF)
- 125 Dependent Care Reimbursement (DOC)
Tuition Remission
- Remission Form (PDF)
- Remission Form (DOC)
- Waiver Form (DOC)
- Waiver Form (PDF)
- Dependency Form (PDF)
- Dependency Form (DOC)
Other:
If you have any problems accessing these forms, please contact Human Resources.
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Human Resources Information:
Phone: (845) 341-4660Fax: (845) 341-4670
Located in Orange Hall,
115 South Street Middletown, NY 10940
occchr@sunyorange.edu