Forms and Worksheets

The following forms and worksheets are available for Medaille College faculty and staff.

• Banner Access
• Check Request
• Credit Card Purchase Request
• Classroom Interruption Student Contact Information
• Direct Deposit
• Graduate Assistant Position Approval
• Hourly Attendance Sheet
• Key Request
• Lost/Missing Receipt Form
• Mileage Reimbursement Request
• Non-Employee Association Form
• Position Approval Form
• Work Program Position Approval Form
• Reimbursement for Associate Teachers
• Stipend Request Form
• Travel Expense Sheet
• Time Off Request

Health Insurance and Benefits

• Medical Benefits Subscriber Claim Form (Group Number: 00412601) from BlueCross BlueShield of Western New York
• Flexible Spending (NOVA)
  • Flexible Spending Accounts Information (2013)
  • IMPORTANT NOTICE Change in Flexible Spending Accounts (effective 1/2011)
  • Flexible Spending Account Enrollment Form (2013)
  • Flexible Spending General Claim Form (2013)
  • Flexible Spending Direct Deposit Form (2013)
• Dental (Lincoln Life and Annuity)
  • Dental Claim Form (rev. 11/10)
  • Group Dental Insurance Summary of Benefits (rev. 2/11)
• 403(b) (TIAA-CREF and AXA Equitable)
  • Medaille College Retirement Agreement for Salary Reduction under Section 403(b)
• Employee Tuition Waiver Benefit
  • Employee Tuition Waiver Procedures and Form

Fax Forms

Printable versions of fax cover sheets for the Buffalo, Amherst and Rochester Campuses.

• Buffalo Campus or
• Amherst Campus and
• Rochester Campus or

Tax and Governmental Forms

• IRS Form W-4 (2013) from the Internal Revenue Service
• New York State Notice of Wage Rate
• New York State Employee's Withholding Allowance Certificate (2013) from the New York State Tax Department (IT-2104)
• New York State Certificate of Exemption from Withholding (2013) from the New York State Department of Taxation and Finance (IT-2104E)
• I-9 (Employment Eligibility Verification) from the United States Citizenship and Immigration Service. All new employees must submit this form and provide the proper identification as directed by this form.

Additional Forms

• Business Card Ordering Form: return to Gwyn Beyer in College Relations at 73 Humboldt, Buffalo Campus.
• College Relations Data Request Form: return to Vicki Ward at 73 Humboldt, Buffalo Campus.
• Event Registration Form: return to Mary Johnson, Emily Kelley or Audrey Grochocki (depending on the location of your event).
• Faculty Textbook Order Form
• Institutional Research and Planning Survey Tracking Form: return to Patrick McDonald in 2 Agassiz.
• IT Equipment Request: return to the IT Department
• Publications Request Form: return to Carla Kestner in 73 Humboldt.
• Student Affairs Program Evaluation Form: return to Mary Johnson in the Student Affairs office, C203.
• Request for Permission to Drive Medaille College Vehicles
• Van Request Form
• Do you have a suggestion for a form that should be added here? Please send an email to (webmaster@medaille.edu).