Forms

COVID-19 Health Screening

• Health Screening Survey Form (English)
• Health Screening Survey Form (Spanish)

ADA Process Forms

• Notice of ADA Conference
• Request for Accommodation 504 ADA
• Section 504 ADA Conference Report Form

Affiliate Forms

• Affiliate University ID Request Form (DOC)
• Affiliate Code of Responsibility Form (PDF)

New Hire Faculty/Staff Forms

• I-9 Employment Eligibility Form (I-9) (PDF)
• Code of Responsibility (PDF)
• New Employee Information (PDF)
• Federal Tax Form (W-4) (PDF)
• State Tax Form (WH-4) (PDF)
• Policy Acknowledgement (PDF)
• Pay Schedule Form (PDF)
• Payroll: Direct Deposit Authorization Form (PDF)
• Voluntary Self-Identification of Disability (PDF)
• Voluntary Self-Identification of Protected Veteran Status (PDF)

General Employment

• Name Change Form (PDF)
• Part-Time Faculty Appointment Form (PDF)

Tuition Remission

• Tuition Remission Authorization form
  You will need to be logged into Google with your Butler credentials.

Recruiting​

• Faculty Position Request Form (PDF)
• Faculty Position Justification Form (DOC)

Onboarding/Exiting Resources

• Employee Exit Checklist (PDF)
• Faculty / Staff Status Form (XLSX fillable form with drop-down menus)​
• Job Aid for Faculty/Staff Status Form (PDF)
• One America Life Insurance Coverage Portability and Conversion (PDF)

Other Resources

• Incident Report Form (PDF)
• Personal Computer Loan Program Certification Sheet (PDF)
• Flexible Work Time Request Form (PDF)
• Butler University Employee Wellness Incentive Form