Human Resources
MSU-Northern
P.O. Box 7751
Havre, MT 59501-7751
Tel: (406) 265-4147
hr@msun.edu

Location:
Cowan Hall 204

Health

• Sick Leave Donation
• Adult Dependent Form
• Alternate ID Request Form
• Family Medical Leave (FMLA)
    Facts
    Request Form
• Dental Claim Form
• EyeMed Out of Network Claim Form

Flex Plan Forms:

• Child Care Contract
• Debit Card Enrollment
• Dependent Care Claim
• Direct Deposit
• Letter of Medical Necessity
• Medical Care Claim
• Instructions/Information:
  • Eligible/Ineligible Expenses
  • How to Fill Out a Claim
  • Online Claims Submission
  • OTC Guidelines
• More forms (external link)
• Other Flex resources can be found on the Benefits page.
  

Miscellaneous

• Faculty/Staff Tuition Waiver
• Dependent Partial Tuition Waiver Application
• Leave Request (Excel)
• Dislocation Allowance Claim Form for faculty

Performance Review

• Role Description (Word)
• Employee Evaluation Cover Sheet
• Employee Performance Evaluation (Word)
• Classified Employee Self Evaluation Form [Optional] (Word)
• Professional/Administrative Employee Self Evaluation Form (Word)

Employment

• MSU-Northern Employment Application
  ( , )
• Background Check Authorization Form
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• EEO Form ( , )
• Employee Check Out List
• Key Requisition/Return

The following forms are available on the
Choices Forms Website:

• Active Enrollment Form
• Retiree Enrollment Form
• Working Families Tax Relief Act Declaration Form
• EyeMed Claim Form
• Delta Dental Claim Form
• Caremark Form
• Ridgeway Mail Order Form
• Cobra Enrollment Form
• Flex Form

Additional Optional Reimbursement Account Forms:

• Cafeteria Plan Forms and Expense Worksheets
• Dependent Care Claim Form
• Medical Care Claim Form