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

	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

	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

	Admin-Faculty Time Off Request
	CSEA Staff Request for Time Off
	Leave of Absence Request Form

Payroll Forms

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

Supervisor Forms

	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

	CSEA Tuition Waiver
	DCC Credit-Free Tuition Waiver Form
	DCC Tuition Waiver Form
	Graduate Tuition Reimbursement (DUE)