Health Benefits
Benefits Forms, Health Benefits
Retirement Programs
Leave & Disability
Benefits Forms, Leave & Disability
Voluntary Benefits Programs
Fee Waiver Program, Fee Waiver Registration Instructions
Fee Waiver Forms, Fee Waiver Program, Fee Waiver Program FAQs, Fee Waiver Registration Instructions
Workers' Compensation, Workers' Compensation Internal Process
Workers' Compensation
Workers' Compensation Internal Process
Academic Personnel Leaves of Absence
Academic Personnel Retirement Programs
Life Insurance
Flexible Spending Accounts
Benefits Forms
The VSP Video Display Terminal (VDT) Confirmation Form is only provided to CSU employees who meet the
necessary job requirements as determined by the CSU campus benefits office. This form must be completed
by the employee and provided to a VSP Select Network doctor to receive the supplemental VDT benefit.
This is an Adobe Sign Form. You will need to log in with your Humboldt username account. Follow the instructions in the landing page.
This is an Adobe Sign Form. You will need to log in with your Humboldt username account. Follow the instructions in the landing page.
This booklet contains information and a payment application to help you select the payment method that best meets your needs.
Employee will need to initiate the form and send it to supervisor for review/approval. Supervisor will need to send the completed form to Ariel.Aaron@humboldt.edu. Please make sure the time is also claimed in Absence Management or claimed on the employee's timesheet
A Cal-Ore Life Flight membership ensures the patient will have no out-of-pocket flight expenses if flown by the Company or another AirMedCare Network participating provider
Career Development Plans use an online submission process which provides the opportunity to sign, gain signatures and submit electronically.
Career Development Plans use an online submission process which provides the opportunity to sign, gain signatures and submit electronically.
Employee’s Report of Injury (DWC-1) – Must be given to employee at the time injury is reported to Supervisor, or as soon as possible after medical treatment is received
Supervisor’s Report of Injury – MUST BE SUBMITTED TO HUMAN RESOURCES WITHIN 24 HOURS OF KNOWLEDGE OF INJURY
Employee’s Report of Injury (DWC-1) – Must be given to employee at the time injury is reported to Supervisor, or as soon as possible after medical treatment is received
Supervisor’s Report of Injury – MUST BE SUBMITTED TO HUMAN RESOURCES WITHIN 24 HOURS OF KNOWLEDGE OF INJURY
Predesignation of a Personal Physician
The document includes links to all the necessary forms for the Workers' Compensation process.
Request for Non-Emergency Medical Transportation for Work-Related Injuries
Available to eligible faculty unit employees only.
Available to eligible faculty unit employees only.
Notary Pages for Approved Sabbatical and DIP Leaves
Tenured Faculty Unit employees who are of normal retirement age (consistent with CalPERS rules and pursuant to the California Code of Regulations (CCR) §586.1) are eligible to participate in the program.
Employer Paid Life and AD&D Beneficiary Designation and Change Form
Attach supporting documentation and submit to ASIFlex
.