Forms, Documents & Tools

To find a form, document or tools, click one of the categories in the gray box below. Each category has a set of forms, documents and tools. When you fill out a form, please make sure to sign and date the form before you send it to the Human Resources office (Skinner Hall, Room 1).

Affiliate/Non-Employee

Forms

• MHC Affiliate/Non-Employee Informations

Benefits

Benefits Overview

Documents

• Get to Know Your Benefits

Tools

• Benefits Calculator

Health & Dental Insurance

Forms

• Blue Cross/Blue Shield Enrollment & Change
• Health Insurance Premium Subsidy
• Waiver
• Fitness Center Reimbursement
• Weight Loss Reimbursement

Documents

• Health Insurance Rates
• Comparison of Plans
• HMO Blue Summary
• Value HMO - HMO Blue New England $500 Deductible Summary
• PPO 90 - Blue Care Elect Preferred 90 Copay Summary
• Dental Plan Summary

Tools

• Health Insurance Selection Tool

Domestic Partnership

Forms

• Domestic Partnership Affidavit
• Domestic Partnership Termination

Life & Long-Term Disability Insurance

Forms

• Life & LTD Enrollment
• Statement of Health

Documents

• Summary Plan Description Basic and Optional Life Insurance
• Summary Plan Description Basic and Optional Long Term Disability

Flexible Spending

Retirement

Forms

• Voluntary Contributions: Payroll Deduction/Reduction Agreement

Documents

• Summary Plan Description Cash Balance Plan
• Summary Plan Description for Defined Contribution Plan(s)
• 403(b) Plan Document
• Investment Policy Statement
• How to Access Your Account - Voya
• Program highlights - Voya

Staff Leave

Forms

• Staff Sick Leave Donation Form & Policy
• Request for Available Time from the Leave Bank
• Parental Leave Policy and Form
• Statement in Support of Need for Domestic Violence Leave

Tuition Benefits

Tuition Benefits

Tuition Exchange

Forms

• Tuition Exchange Application
• Tuition Exchange Recertification Application

Taking classes at MHC

Forms

• Employee Enrollment
• Dependent or Spouse Enrollment
• Frances Perkins Course Enrollment

Tuition Reimbursement

Forms

• Employee Tuition Reimbursement Application

Tuition Waiver for Daughters

Forms

• Waiver Application (Please attach Birth Certificate)

Employment

Forms

• Demographic and Online Directory Information
• Employment Application (Online application)
• EEO Information Request
• Employee Conference

Payroll

Faculty/Staff

Please go to: MyMountHolyoke

Student

Forms

• I9 Instructions
• I9 Form-Paper Version
• I9 Form-Fillable Version
• Federal Tax Form W4
• Mass State Tax Form M4
• Student Direct Deposit Form

Performance Management

Forms

• Performance Evaluation - Narrative
• Performance Evaluation - Original

Documents

• Performance Evaluation Memo 2015
• Community Reference Guide

Salary Administration

Forms

• Job Analysis

Documents

• Salary Grade Range Chart

Worker's Compensation

Forms

• Employer's First Report of Injury or Fatality Form 101
• Supervisor's Accident Investigation Report [print and fill-out by hand]
• Supervisor's Accident Investigation Report [fill-out on computer, then print]
  Note: This form documents the supervisor's investigation and needs to be submitted after the investigation is complete and within 7 calendar days of the accident.
• Medical Treatment
• Medical Release