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Dental Enroll/Transfer Form

As a new member you are automatically enrolled in the Scheduled Benefit Plan. If you wish to enroll in one of the other UFT Welfare Fund dental options use this form. All other members and retirees who wish to transfer from one UFT Welfare Fund...

Chancellor's Reg. A832 re student-to-student discrimination, harassment, intimidating and/or bullying

Chancellor's Regulation A-832: This regulation establishes a procedure for the filing, investigation, and resolution of complaints of student-to-student discrimination, harassment, intimidation, and/or bullying.

OP 255: Resumption of Service Report

Upon an employee’s return from a leave of absence without pay, the payroll secretary must submit an OP 255 form to the Bureau of Salary Differentials and Status.

Facility-Wide Inventory of Mercury and Mercury-Containing Devices

Especially for Lab Specialists. Use Page 1 to document the presence of mercury in a science room.

Dependent Child Affidavit

Fill out and have this form notarized for your dependent child to ensure coverage by the UFT Welfare Fund benefit plan.

School-based plan to support immigrant students and families

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.

Direct Access Dental Plan

This fully explains the benefits available under the UFT Welfare Fund Direct Access Dental Plan (SIDS – Self-Insured Direct Services) and includes a subscription form at the end.

Annual DOE teacher shortage areas for additional compensation

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

Membership Application (Retired Teachers)

Print and complete the retired teachers’ application only if you are not able to use the online enrollment form.

Florida PPO Panel - Dental Schedule

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...

Provider/Program Enrollment or Update Request Form

Administration for Children's Services Division of Child Care/Head Start Child Care Support Services; Provider / Program Enrollment or Update Request

Prescription Appliance and/or Medical Equipment Claim Form - HIP Subscribers Only

For HIP subscribers only, includes a section for member and physician to fill out. Please attach original, itemized, paid bill showing date and item purchased.

Anesthesia Benefit Claim Form - HIP Subscribers Only

Although the cost of anesthesia for hospitalization, emergency illness or accidental injury should be covered in full by HIP/HMO, the Welfare Fund will pay 80% of reasonable, usual and customary charges when not covered by HIP/HMO.

Dental Schedule

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...

Comprehensive Injury Report

This form details the nature of your injuries. It should be turned in to your principal within 24 hours of your accident or illness.

HIPAA: Privacy Practices Statement

Read this notice of privacy practices to understand how protected health information about you may be used and disclosed and how you can get access to this information.

Dentcare HMO brochure

Brochure for Dentcare HMO

C-11: Change of Employment Status

Change in employment status includes return to work, discontinuance of work, increase or decrease of regular hours of work and increase or reduction of wages.

Documents required for dependent health benefits

List of supporting documents required for enrolling dependents in health benefits

Advance at a Glance - key dates for teacher evaluation

Key Dates and Reminders for the School Year

Transit Benefit Program Enrollment Form

Save more than $200 each year in taxes by participating in the city’s TransitChek program.

Advance FAQ

See answers to frequently asked questions about the Advance evaluation system in this DOE FAQ.

DOE sabbatical memo

Timeline and guidelines for applying for sabbaticals