Human Resources

Benefits Forms

Below you will find commonly used Insurance, Retirement and Flexible Spending Account Forms. In addition, there may be times that you have to obtain forms directly from some benefit vendors. Here are links to certain vendor Web sites:

Insurance Forms

Retirement Forms

To retrieve the TSERS forms below go to NC ORBIT. Then navigate to FORMS then Beneficiary Designation Forms. Finally select the desired form from the available list.

Disability Forms

To retrieve the disability forms below go to NC ORBIT. Then navigate to FORMS then Disability Application Forms. Finally select the desired form from the available list.

  • 701-Requesting the Short-Term of Benefits through the Disability Income Plan of North Carolina
  • 703-Medical Report for Eligibility Review of Short-Term Disability Benefits
  • 7A-Medical Report for Disability Eligibility Review

Spending Account Forms

Winston-Salem State University

601 S. Martin Luther King Jr. Drive

Winston-Salem, NC 27110

Phone: (336) 750-2000



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