Forms

The City University of New York offers a comprehensive benefits package to meet the needs of its employees and their families, including health, welfare, retirement, and other programs. Your benefits program is based upon your employee classification. As your needs evolve over time, you will be able to make certain changes to your coverage during the Annual Transfer Period, or within 30 days of a qualifying event.

The following website will allow you to review a summary of available benefits and to research your benefit plans in more detail:

Benefits and Wellness

Direct access to forms can be found here:

Benefits Forms

Should you have any questions, please do not hesitate to contact our campus Benefits Manager, Tanya Solivan at Tanya.Solivan59@citytech.cuny.edu.

Election Day Request Form

Veterans Day Request Form

Classified Staff (White Collar) Bi-Weekly Timesheet

Non-Teaching Instructional Staff Bi-Weekly Timesheet

HEO Request for Overtime/Compensatory Time

Dedicated Sick Leave Policy and Forms

Paid Parental Leave Policy and Application

Military Leave

Special Leave of Absence

Childcare Leave of Absence

Personal Emergency Leave

Request For Leave Form

Request for Reasonable Accommodation

Reasonable Accommodation - Healthcare Provider Assessment Form

FMLA Leave Policy

FMLA Eligibility, Rights and Responsibilities Notice

Fitness for Duty Certification

FMLA Request Form

FMLA Certification - Family Relationship

FMLA Health Care Provider Certification - Employee

FMLA Health Care Provider Certification - Family Member

FMLA Certification - Military Family Leave

FMLA Certification - Military Caregiver Leave

FMLA Military Family Leave - Certification of Qualifying Exigency

Memorandum of Transmittal - 3-Year Teaching Adjunct Appointment Consideration

Fellowship Conference Memo

Promotion Conference Memo

Faculty Annual Evaluation - Guidance for the Evaluator

Faculty Annual Evaluation - Conference Memo (DOCX)

Classroom Observation Form - Fillable

Online Hybrid Classroom Observation Form - Fillable

HEO Series Annual Evaluation Form

College Laboratory Technician Evaluation Conference Memorandum

Reappointment Conference Memo

Post-Observation Conference Memo

Student Evaluation of Teaching - SAMPLE

Student Evaluation of Teaching SAMPLE - HYBRID COURSE

Payroll and Tax Forms

Direct Deposit Forms

Federal W-4 Form

NYS IT-2104

Academic Certification

CLT Promotion Guidance

College Laboratory Technician Application for Promotion

Document Certification for Promotion

Document Certification for Reappointment

Election Declaration of Candidacy

Election Nomination Petition (Delegate at Large to the College Council)

Fellowship Leave Application

HEO Assignment Differential Request Form

HEO Reclassification Request Form

HEO Request for Overtime/Compensatory Time

HEO Workload Review Form

Memo of Transmittal

Memo of Transmittal - Department Appointments Committee Election

Multiple Position Application - Non-Teaching Instructional Staff

Multiple Position Policy

Multiple Position Report

NYCCT Curriculum Vitae(CV) Format

PARSE Archival Disc Cover Page

PARSE Form

PEER Committee Report

PEER Committee Signature Page

Personal Data Form

Phased Retirement Application for Faculty

Phased Retirement Application for Professional Staff

Professional Reassignment Leave Application - Library

Professional Development Plan

Request for Personnel Action

Scholar Incentive Award

Workload Declaration Form