forms
Benefits Office
Phone: 304-766-3152
Fax: 304-766-4261
Campus Address: 110 Cole complex
Hours: Monday – Friday
8:30 a.m. – 5:00 p.m.
Human ResourcesBenefits Office
Disability
- Long-Term Disability Benefits Claim Packet Instructions
- Short-term Disability Benefits Claim Packet Instructions
Health Insurance
- PEIA Forms
- Includes forms such as:
- Change-in-StatusÂ
- Change of AddressÂ
- Beneficiary Update
- Dependent Out of Area Form
- Includes forms such as:
- PEIA Shopper’s Guides
- PEIA Plan Documents
Retirement
- FBMC Retiree Enrollment form
- PEIA Retiree Health Benefits and Basic Life Insurance Enrollment Form
- PEIA Retiree Optional/Dependent Life Insurance Enrollment Form
- State Teacher’s Retirement System (STRS) Enrollment Form
- TIAA 403(b) Enrollment
- TIAA 457(b) Enrollment
- TIAA Beneficiary Change
- TIAA Change in Address Form
- TIAA Name Change
Voluntary Benefits
- Delta Dental Claim Form
- MetLife Vision Out-of-Network Claim Form
- Mountaineer Flex Benefits Enrollment/Change in Status Form   Â
- PayFlex Flexible Spending Account Claim Form
- PayFlex Health Savings Account Transfer Request Form
- PEIA Optional/Dependent Life Insurance Enrollment Form
- PEIA Basic and Optional Life Change of Beneficiary Form
Tuition Waiver