Benefits Forms | Human Resources | UNC Charlotte

Benefit	Form
Change of Address	Log in to my.uncc.edu > Select Banner Self-Service > Personal Information > Address Change
Leave Benefits (FMLA - 12 Month)	Paper Form: 12 Month FMLA (Extended Leave of Absence Resource Guide) Family Illness Leave (Used after FMLA is exhausted) (for care of spouse, child, or parent) Online Form: Online FMLA Application (Part A) If completing the online FMLA Application, the following paper forms are also required: FMLA Medical Certification (Part B) - You need to use the firefox browser to open the 380-E, and 380-F forms: Employee’s serious health condition, form WH-380-E • Family member’s serious health condition, form WH-380-F FMLA Supervisor Certification (Part C) FMLA Fitness for Duty Submit forms securely to the Benefits Office
Leave Benefits (FMLA - 9 Month Faculty)	Must complete both forms below: 9 Month Faculty FMLA (Extended Leave of Absence Resource Guide) (Send to Benefits Office via secure method) Request for Leave of Absence (9 month Faculty AA-32) (Form to complete and send to Academic Affairs)
Leave Benefits (Non FMLA - 9 Month Faculty)	Request for Leave of Absence (9 month Faculty AA-32)
Leave Benefits (Voluntary Shared Leave)	Application: Voluntary Shared Leave Application Donation Voluntary Shared Leave Donation Form
Leave Benefits	Leave without Pay Application
Leave Benefits	Paid Parental Leave Request Form
NCFlex	Accidental Death and Dismemberment Forms Cancer Insurance Forms Critical Illness Insurance Forms Dental Forms Flexible Spending Account Forms Group Term Life Forms Vision Forms
Prior Service	Prior Creditable State Service Verification Form
Retirement	Optional Retirement Plan Forms Teachers' and State Employees' Retirement System Forms
Separation	Employee Separation Form Partial Separations - reference the separations webpage for instruction