Experience It.

Forms and Worksheets

The following forms and worksheets are available for Medaille College faculty and staff. You will need Adobe Acrobat Reader to view and print these documents.

Banner Access: for new full-time and part-time faculty, administrators and staff

Check Request: for faculty and staff. This form can be filled out online.

Credit Card Purchase Request: return to the Business Office.

Direct Deposit: Paychex form to set up direct deposit to your bank account.

Hourly Attendance Sheet: part-time and full-time employees; return to HR/Payroll

Mileage Reimbursement Request

Non-Employee Association Form

Position Approval Form

Reimbursement for Associate Teachers: for student teachers

Stipend Request Form

Travel Expense Sheet

Tuition Reimbursement

Vacation / Personal Day Request

Van Request Form: please return to Kari Costelloe in Academic Affairs, M201

Health Insurance and Benefits

Medical Benefits Subscriber Claim Form (Group Number: 47434) from Blue Cross Blue Shield of Western New York

Flexible Spending (Independent Health)
- Flexible Spending Account Enrollment Form (2010)
- Flexible Spending Account Benefit Plan Q&A (PDF)
- Flexible Spending Handbook (PDF)
- Flexible Spending Reimbursement Form
- Flexible Spending Dependent Care Expenses
- Flexible Spending Eligible Healthcare Reimbursement Expenses (PDF)
- Flexible Spending Eligible OTC Medical Expenses (PDF)

Dental Claim Form from First Ameritas

Employee Tuition Waiver Benefit
Form (PDF) | Procedures

Medaille College Retirement Agreement for Salary Reduction under Section 403(b)

Fax Forms

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

Buffalo Campus (Adobe PDF) and (Microsoft Word)

Amherst Campus (Adobe PDF) and (Microsoft Word)

Rochester Campus (Adobe PDF) and (Microsoft Word)

Tax & Governmental Forms

IRS Form W-4 (2010) from the Internal Revenue Service

W-5 (Earned Income Credit Advance Payment Certificate) (2010) from the Internal Revenue Service

New York State Notice of Wage Rate

New York State Employee's Withholding Allowance Certificate (2010) from the New York State Tax Department (IT-2104)

New York State Certificate of Exemption from Withholding (2010) 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.

Campus Center Signboard Form: (58K) return to Lakeisha Flood, Director of Student Activities, in the Campus Center.

College Relations Data Request Form: return to Vicki Ward in 73 Humboldt, Buffalo Campus.

Event Registration Form: return to Mary Johnson, Jessica Lane, or Audrey Grochocki (depending on the location of your event).

Faculty Textbook Order Form: (8K) return to Mike Healy, College Store Manager, in the Campus Center.

Institutional Research and Planning Survey Tracking Form: return to Patrick McDonald in 2 Agassiz.

IT Equipment Request: (22K) return to the IT Department in the Main Building.

Student Affairs Program Evaluation Form: return to Mary Johnson in the Student Affairs office, C203.

Do you have a suggestion for a form that should be added here? Please contact Kara Kane (kara.m.kane@medaille.edu), ext. 2884.