This form must be completed and submitted to the per session supervisor prior to commencement of employment in a per session activity. Waivers for per session activities that will exceed 400 hours must be submitted electronically through the DOE's...

These instructions explain how to fill out your dental claim form either after treatment or for pre-treatment estimates for more complicated procedures such as periodontic surgery, bridges, crowns, inlays, dentures and other procedures that cost over...

This form is used to transfer accrued per-session sick leave to the employee's regular cumulative absence reserve.

This form is for retired members who have elected a New York City optional rider or New York City health plan, or are covered under their spouse’s/domestic partner’s NYC health plan.

Registered family and licensed group providers whose rates listed on file with ACS are not already higher than the 2007 market rate should use this form to apply to receive the new market rate moving forward and retroactively.

This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules...

Moving forward, all informal providers will receive the standard 2007 market rate without having to apply. In order to receive the 2007 rate retroactively, informal providers must apply for it and attest that their cost of care has increased. Please...

This form for Lab Specialists is taken from the DOE Science Safety Manual.

Use this confidential form to notify the UFT School Safety Department if you have been the victim of an incident and/or injury. Or fill out the online incident report form.

For NYCE PPO in-service members only, the Welfare Fund will reimburse up to $100/year of the deductible for the purchase or rental of durable medical equipment, with this form and an original Explanation of Benefits (EOB).

This form is for retired members who have elected a non-New York City optional rider for health insurance or prescription plan, or are covered under their spouse’s/domestic partner’s non-NYC health plan.

The UFT Health & Safety Department offers workshops on health and safety issues on staff development days, union meetings, etc. If you would like to have one of these workshops offered to your chapter, please fill out this form and send it to the...

For Welfare Fund members who are using a non-participating dentist, your reimbursement will be according to this dental fee schedule; for those using a participating dentist, there will be no cost to the member except for co-pays listed in this...

Annual DOE list of teacher license area shortages which may qualify members licensed in these areas for additional compensation.

For UFT members in the Florida area, this is the Schedule of Benefits. When you use a UFT Welfare Fund participating dentist, you will be provided with the services listed in the Schedule of Covered Dental Expenses without charge except for those few...

Timeline and guidelines for applying for sabbaticals

This form is for payroll secretaries.

After you have read the dental claim form instructions (below) you are ready to fill out the dental claim form as needed.

UFT membership application for all DOE titles except paraprofessionals. Print, complete and submit this application form only if you are not able to use the UFT's online enrollment form.

Workers’ compensation intake form for Paraprofessionals, School Nurses, Occupational and Physical Therapists:

Use this form to claim out-of-pocket expenses related to your injury or illness.

This is your Medicare Part D Reimbursement Claim Form, for retired members and their spouses/domestic partners.

You may authorize the UFT to use/disclose your protected health information by filling out this form.

This price waiver form must be completed by both the member and his/her physician in cases where a brand rather than generic prescription is deemed medically necessary.

Informal providers should use this form to record any training sessions they attend. Informal providers who complete 10 or more hours of approved training in at least two different approved topics may be eligible to receive a higher, "enhanced"...

Members on an approved Child Care Leave who are currently covered by the UFT Welfare Fund are eligible to receive extended UFT Welfare Fund benefits for up to a maximum of six (6) consecutive months for the birth or adoption of a child.

Complete a separate application for Young Adult Coverage for each dependent child between the ages of 26-29 for whom you are requesting coverage by the UFT Welfare Fund.

Brochure for Dentcare HMO

The UFT has developed this worksheet to support the work of school-based committees to defend immigrants. It can help committees identify questions, locate current policies and find resources to protect the students they serve.

Legal referrals injury claim form

This application form is to be used only by pedagogical personnel who have received a regular appointment.