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Information and application for GIC coverage for unmarried dependents ages 19-26. 

Find all the forms you need to apply for GIC coverage.

Social Security Information Form SSA-1945 (pdf)

Statement concerning your employment in a job not covered by Social Security.

Tuition Remission Form for UMass Lowell campus (Docusign)

Direct Deposit Form (pdf)

All employees are eligible for direct deposit. Please note that it can take up to two pay periods for direct deposit to take effect; for these periods you will receive a check. 

Mandatory OBRA Enrollment/Beneficiary Form  (pdf)

Temporary employees are required to participate in the Massachusetts Deferred Compensation SMART Plan (also known as Mandatory OBRA).

Form for Students Working During the Summer (pdf)

During the academic year, students who are enrolled for six credits and who are working on campus are exempt from the OBRA retirement contributions (as well as the FICA/Medicare deductions). During the summer, these deductions will be withheld except for those students who meet specific summer enrollment criteria.

FMLA Request Form  (pdf)

Form to request a Family Medical Leave.

Temporary Personnel Action Form (PAF)  (pdf)

Hiring officials use this form to record all personal, job and compensation data for a temporary employee.

Instructions for Completing the Temporary Employee PAF (doc)

Instructions for completing the Personnel Action Form (PAF) for temporary employees. 

New temporary employees complete this packet of forms for employment eligibility.

I-9 Employment Eligibility Verification Form (pdf)

All new employees must use this form to document both that they are eligible to work in the United States and that their identities match the information on their employment authorization documents.

Request for Services for New Faculty/Staff Form (pdf)

If you need access and/or parking before your completed paperwork has been turned in and/or entered into the system you may complete and return this form it to the UCAPS office.