Green Hall Clock Tower

Use the links below to access the forms that update your Benefits Information or to request a leave of absence.

Pension & Life Insurance Forms

• ABP Designation of Beneficiary
• ABP – Application for Retirement Information
• Designation of Beneficiary
• TCNJ Retirement/Resignation Notice
• Salary Agreement and Vendor Allocation Form
• NJ Deferred Compensation & Roth 457 Enrollment Form
• NJ Deferred Compensation & Roth 457 Beneficiary Form
• NJ Deferred Compensation & Roth 457 Salary Deferral Change Form

Health & Dental Forms

• NJ Direct Claim Form
• Prescription Drug Reimbursement Form
• Vision Care Reimbursement Form
• Affidavit of Dependency Form
• State Employee Waiver/Reinstatement Form
• Health Insurance Application Form
• Dental Insurance Application Form

Furlough & Leave Forms

• Doctor’s Verification of Family Leave Needed to Care for Sick Relatives
• Memo to Update Medical Leave Request
• Confidential Medical Leave Request
• Certification of Qualifying Exigency for Military Family Leave
• Medical Leave Not Covered Under FMLA
• Personal Leave of Absence Form
• Federal FMLA Leave Request Form
• NJ FLA Leave Request Form
• CWA & IFPTE Self-Directed Furlough Request Form
• Request for Voluntary Furlough form