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Forms

Dutchess Community College is committed to the principle of diversity and encourages applications from women, minorities, veterans, the disabled and all others (AA/EOE).

General Forms

General forms icon ADA Medical Certification Form
ADA Reasonable Accommodation Request Form for Employees
Charge of Discrimination Form
Charge of Sexual Harassment Form
Comp Time Request - NTE
DCC SUNYCard Application Form
Employee Personal Information Form
Outside Compensated Activities Approval Form
Parking Permit Application

Medical and Dental

medical and dental icon ADA Medical Certification Form
ADA Reasonable Accommodation Request Form for Employees
CSEA MVP Health Care Benefit Summary Sheet
CSEA NYSHIP Health Care Benefits at a Glance
DEHIC Empire BCBS Claim Form
DEHIC Empire BCBS PPO EPO 20 BVV OE Booklet
JJ Stanis Dental Benefits Booklet
JJ Stanis Dental Claim Form
JJ Stanis Dental Student Status Request

Leave of Absence/Time Off Request

leave of absence forms icon Admin-Faculty Time Off Request
CSEA Staff Request for Time Off
Leave of Absence Request Form

Payroll Forms

payroll icon Address Change / Name Change
Direct Deposit Form
Withholding Certificate Federal W-4
Withholding Certificate NYS IT-2104 Fill-in

Supervisor Forms

supervisor forms icon Administrative Appointment
Administrative Recruitment
Civil Service Appointment
Civil Service Performance & Work Appraisal Form
Civil Service Recruitment Form
Faculty Appointment
Faculty Recruitment
In Service Training Authorization
Interview Guide
Outside Compensated Activities Approval Form
Payment-Compensatory Request Form
Professional Development Report
Supervisors Report of On the Job Injury or Incident
Telephone Reference Questionnaire

Tuition Reimbursement & Waiver Requests

icons for tuition reimbursement forms CSEA Tuition Waiver
DCC Credit-Free Tuition Waiver Form
DCC Tuition Waiver Form
Graduate Tuition Reimbursement (DUE)