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People, Belonging, & Culture
Forms for Download
Find here all available People, Belonging, & Culture documents for download.

Benefits

Medical / Dental / Vision

  • Prescription Drug Claim Form
  • United Concordia Companies Inc. (UCCI) Claim Form
  • United Concordia Companies Inc. (UCCI) Dep. Certification Form
  • EyeMed Claim Form
  • Carefirst Claim Form
  • Carefirst HIPPA Authorization Form
  • Waiver of Coverage Form
  • HIPAA Release Form
  • Partner Affidavit
  • Tax Dependent Status Form
  • HIPAA- Notice of Privacy Practice 

Life Insurance

  • Aetna EOI Form
  • Aetna Beneficiary Designation Form

Miscellaneous

  • Johns Hopkins FCU Membership Application
  • Loan Request Form
  • Professional Services Agreement Form (Independent Contractor)
  • Tuition Remission Form
  • Workday Delegations Policy

Employment

  • Business Card Request Form + (Policy)
  • New Hire Technology Set-up Request Form
  • Employee Data Record

Payroll

  • Calendar Year 2023-2024 Payroll Calendar
  • Certification of Academic Activity
  • Understanding Your W2
  • W-2 Reissue Form
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MICA 1300 W Mount Royal Ave Baltimore, MD 21217 410.669.9200
© 2023 Maryland Institute College of Art

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