Search
OP 175: Application for per session employment & retention rights
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...
Per Session Unused Sick Time Transfer Form
This form is used to transfer accrued per-session sick leave to the employee's regular cumulative absence reserve.
T-Bank Stop Payment Request Form
This form is for payroll secretaries.
OP 505G: Claim for Loss or Damage of Eyeglasses
Use this form to file a claim if your eyeglasses were damaged in an assault.
Accommodation Request for Individuals with Disabilities
If an accommodation request is denied or cannot be provided through informal means, the employee may apply for a formal accommodation by submitting the Accommodation Request Form on page 2. Medical documentation to support the request must be...
Student Removal Form
See Chancellor's Regulation A-443 for information on student disciplinary procedures and student removal.
Mandatory Generic Price Waiver 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.
Medicare Part D Creditable Coverage Disclosure Notice
For members: this notice has information about your current prescription drug coverage with the UFT Welfare Fund and your options under Medicare’s prescription drug coverage. Please read carefully.
Optional Rider Claim Form - NYC Health Insurance Plans
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.
Optional Rider Claim Form - Non-NYC Health Insurance Plans
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.
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.
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...
Personnel Memorandum #4, 2002-2003: Policy and Procedures on Line of Duty Injuries for Pedagogical Employees
This circular consolidates and updates the Department of Education’s policies and procedures on line of duty injuries for pedagogical employees previously detailed in Special Circular No. 32, 1989-90: Personnel Memorandum No. 19, 1986-87 and...
Chancellor's Regulation C-606: Time Off for Religious Observance
Accommodations and procedures for requesting time off for religious observance.
DOE Memo: Continuation of Extended Rights and Benefits for Military Leave
This memo, dated Dec. 13, 2002, details the Department of Education's policy regarding the city's Extended Military Benefits Package.
Heads of Bureau Circular #11, 1973-1974: Maternity and Child Care Leaves
Regulations governing leaves of absence for maternity and/or child care for administrative (non-pedagogical) staff. Page 1 of this document is Heads of Bureau Circular #15, 1975-1976, which amends a section of Circular #11.
Personnel Memorandum #54, 1995-1996: Family and Medical Leave Act
The purpose of this memorandum is to describe the benefits and eligibility requirements of the Family and Medical Leave Act (FMLA).