Nyu Benefit Plan Application Form PDF Details

The New York University Portable Tuition Benefit Plan Application provides a significant avenue for the dependent children of former full-time NYU employees, excluding those associated with the Medical School, to receive financial support for undergraduate studies at colleges or universities other than NYU. To be eligible, these employees must meet specific criteria regarding retirement, disability retirement, layoff, or death, as the benefit specifically excludes children of employees lacking these qualifications. Applicants are instructed to thoroughly read NYU's policy, fill out all sections of the application form, attach an itemized bill for the current term inclusive of any scholarships or awards, and if necessary, attach proof of the dependent relationship. The processing of payments is managed by EBPA, with a structured timeline that mandates submission by certain dates to accommodate the academic schedule of the dependent child's institution. The form requires detailed information about the former NYU employee, the dependent child, and the academic details pertinent to the tuition payment process. Acknowledgement of the policy's terms and certification of the dependent child's status and enrollment by the former employee is a critical step in the application. This comprehensive approach ensures that benefits are administered correctly and efficiently to support the educational endeavors of eligible dependent children.

QuestionAnswer
Form NameNyu Benefit Plan Application Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesretiree, 28th, NH, 30th

Form Preview Example

NEW YORK UNIVERSITY

PORTABLE TUITION BENEFIT PLAN APPLICATION

Questions About a Payment? Call EBPA at

1-800-578-3272

For Dependent Child of Former Full-Time NYU Employees (excluding the Medical School) Attending Undergraduate College Or University (Other Than NYU)

Administrative/Professional (100), Faculty (102), Professional Research (103)

EXCLUSIONS: The benefit does not extend to children of employees, who do not meet the eligibility requirements for retirement, disability retirement, layoff, or death. See the policy for details.

Instructions:

Read the policy (www.nyu.edu/hr) and complete all sections of this form

Attach an itemized bill for the current term. Bill must include any awards or scholarships received

If you do not have proof of relationship on file in the NYU Benefits Office, attach a copy of the proof to this form (see policy at www.nyu.edu/hr for details including required proofs)

Payments are processed by EBPA. Mail form to: EBPA, Reimbursement/FSA, PO Box 1140, ExEter, NH 03833-1140

EBPA will mail a check to the dependent child’s college or university within 3 weeks of receipt of a properly completed application and documentation. This application must be submitted in time to meet the deadline for payment at the dependent child’s school. Each school has a different schedule for payments.

Applications will be accepted by EBPA beginning July 1st but must be received no later than:

November 30th for the fall term

February 28th for the winter term

April 30th for the spring term

September 30th for the summer term

If you have questions about a payment to a school, call EBPA at 1-800-578-3272

Former NYU Employee Information

Last name

 

First name

 

 

SSN

 

 

 

 

 

 

 

Residence address

 

City

 

State

Zip

 

 

 

 

 

 

Home telephone (include area code)

 

Month/Year of Separation from NYU

 

(__ __ __) __ __ __ - __ __ __ __

 

 

__ __ / __ __ / __ __ __ __

 

 

 

 

 

Check former employee’s classification:

 

 

 

Faculty (102)

Professional Research Staff (103)

Administrative & Professional Staff (100)

If a spouse (or same sex domestic partner) is currently employed by NYU or meets the eligibility rules as a retiree, or lay off, provide the following information:

Last name

First name

SSN

 

 

 

Dependent Child Information (Information in this section relates to the dependent child who is a full-time student matriculated for an undergraduate degree attending an accredited college or university, other than NYU)

Last name of dependent child

 

First name of dependent child

 

SSN of dependent child

 

 

 

 

 

Name of undergraduate institution

 

 

Date of birth of dependent child

 

 

 

______/______/__________

 

 

 

Date this dependent child began undergraduate study

Application is for academic year 20__ – 20__; payments should be made by:

______/______/__________

semester

trimester

quarter

 

 

 

The dependent child named above is a dependent of the former NYU employee and is (check one)

 

the biological child

the legally adopted child

 

 

the stepchild, who is the biological or adopted child of my current spouse

 

 

the biological or adopted child of my registered same sex domestic partner (under current IRS regulations benefits paid to such a child would be taxable to the former NYU employee)

Former Employee’s Statement By this application, I acknowledge that I have read in full the NYU policy governing portable tuition benefits on the HR website certify that the person named on this application is a dependent child as defined in the policy and is matriculated in an undergraduate degree program at an accredited college or university other than NYU.

Former Employee’s Signature

 

Student Signature

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

How to Edit Nyu Benefit Plan Application Form Online for Free

It is possible to complete Exeter without difficulty with the help of our online tool for PDF editing. FormsPal is devoted to making sure you have the absolute best experience with our tool by regularly introducing new capabilities and upgrades. Our editor has become a lot more user-friendly as the result of the most recent updates! Now, working with documents is simpler and faster than ever. To get the ball rolling, consider these easy steps:

Step 1: Click the "Get Form" button above on this webpage to get into our PDF tool.

Step 2: Once you start the tool, there'll be the document made ready to be completed. Besides filling in various blanks, you might also perform various other actions with the Document, specifically writing custom text, changing the original text, adding graphics, putting your signature on the form, and much more.

Filling out this form calls for attentiveness. Ensure that every blank is completed accurately.

1. The Exeter usually requires particular details to be entered. Be sure that the following fields are filled out:

retiree completion process outlined (part 1)

2. After completing the last step, go to the next stage and fill out the essential details in these blanks - Date this dependent child began, Application is for academic year, semester, trimester, quarter, The dependent child named above is, the biological child the stepchild, the legally adopted child, to such a child would be taxable, Former Employees Statement By this, Former Employees Signature, Student Signature, and Date.

the legally adopted child, semester, and trimester of retiree

Be extremely attentive when filling in the legally adopted child and semester, because this is where a lot of people make errors.

Step 3: Reread all the information you have inserted in the form fields and hit the "Done" button. Join us right now and instantly gain access to Exeter, prepared for downloading. Every single edit you make is conveniently preserved , helping you to modify the form further if needed. FormsPal is invested in the confidentiality of all our users; we always make sure that all personal information entered into our editor is confidential.