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Kansas State University

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Technical Support for Forms:
Kathy Kugle (785) 532-1885
or email kkugle@ksu.edu

Forms

Division of Human Resources
Kansas State University
103 Edwards Hall
Manhattan, KS 66506-4801
785-532-6277
785-532-6095 (fax)
8 a.m. - 5 p.m. (CST)
Contact HR

Alphabetical Forms

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  •  D |
  •  E |
  •  F |
  •  G |
  •  H |
  •  I |
  •  K |
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  •  M |
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  •  W
Alphabetical List of Forms
FORMS by NameDatedInstructions
or Information		 Versions
Above Step Request (PER-3) 10/2003 PPM 4450.30 RTF Word PDF  
Academic Personnel Forms  Academic Personnel     
Accident/Injury Report (PER-17) (Workers' Compensation) 02/2007 PPM 4820.100 RTF Word PDF  
Additional Pay 01/2007 Faculty Awards
PPM 4650.110		 RTF Word PDF 
Additional Pay Checklist #1 4/2001 Faculty Awards
PPM 4650.110		 RTF Word PDF 
Additional Pay Checklist #2 04/2005 Faculty Awards
PPM 4650.110		 RTF Word PDF 
Administrative Leave Reporting 6/2003 PPM 4860.20 RTF Word PDF 
Affiliated Person or Emeritus Faculty Form (PER-22) 7/2006 Included RTF Word PDF  
Affirmative Action Classified Selection Report (PER-10)   Affirmative Action-Recruitment RTF Word PDF 
Affirmative Action Forms   Affirmative Action       
Agency Payroll Deduction Authorization 5/2007 Agency Payroll Deductions RTF Word PDF 
Agreement of Understanding for Overlapping Appointment (PER-28) 10/2004 Military Service Policy RTF Word PDF 
Agreement for Limited Term Appointment (PER-43) 10/2004 PPM 4460.40 RTF Word PDF 
Agreement for Reimbursement of Moving Expenses(DA-22) 11/1998 Moving Expenses RTF Word PDF 
Agreement for School Employee Appointment (PER-21) 3/2004   RTF Word PDF 
Annual Review of Classified Position Descriptions (PER-26) 07/2008 PPM 4210 RTF Word PDF 
Application for President's Scholarship (PER-32A) 01/2007 PPM 4870.40 RTF Word PDF  
Application for Tuition Assistance (PER-32) 05/2007 PPM 4870.30 RTF Word PDF 
Application Procedures for Domestic Graduate Assistants Background Checks RTF Word PDF  
Application Procedures for Non-Resident Alien Previously Residing in US Background Checks RTF Word PDF  
Application Procedures for Non-Resident Alien Not Previously Residing in US Background Checks RTF Word PDF  
Appointment Form (PER-38) 09/2008 Unclassified
Classified		 RTF Word PDF 
Authorization to Release Information 10/2004 PPM 4010 RTF Word PDF 
Background Check Request Form (PER-59)08/2008Background ChecksRTF WordPDF 
Beneficiary Designation (KPERS-7/99) 07/2006 PPM 4820.60    PDF 
Benefits Forms   Benefits Administration       
Change or Separation Form (PER-39) 12/2006 Unclassified
Classified
Grad Student		 RTF Word PDF 
Classified Employee of the Year Award & Recognition Program Monetary Award Payment Form (PER-7) 03/2007 Guidelines RTF Word PDF  
Classified Staff Forms   Checklist
Transaction Guidelines		       
Conflict of Interest Form   Conflict of Interest Policy      Online
Delta Dental Claim Form 06/2002 Dental Insurance    PDF 
Designation of Beneficiary (KPERS-7/99) 07/2006 PPM 4820.60    PDF 
Direct Deposit of Employee Pay (PER-58) 12/2007 Instructions
Information		 RTF Word PDF 
Documentation of Service for Immediate Participation in Regents Retirement Program (PER-33) 01/2007 PPM 4810.20 RTF Word PDF 
Duplicate W-2 Request Form   Information RTF Word PDF 
Educational Authorization Form (PER-25) 5/1998 PPM 4870.20 RTF Word PDF 
Emeritus or KSU Affiliated Employee Form (PER-22) 7/2006 Included RTF Word PDF 
Employee Conference Form  PPM 4020    PDF  
Employee Performance Review System-
Employee Performance Review (PER-47)		 03/2006 Instructions
Presentation in PPT
Supervisor's Guide - Action Steps (PDF)
Training		 RTF Word PDF 
Employee Performance Review System-
Employee's Annual Report of Activities (PER-48)		 09/2004 Instructions
Presentation in PPT
Supervisor's Guide - Action Steps (PDF)
Training		 RTF Word PDF 
Employee Peformance Review System-
Professional Development and Growth Plan (PER-49)		 09/2004 Instructions
Presentation in PPT
Supervisor's Guide - Action Steps (PDF)
Training		 RTF Word PDF 
Employee Performance Review System-
Performance on Goals and Projects (PER-50)		 09/2004 Instructions
Presentation in PPT
Supervisor's Guide - Action Steps (PDF)
Training		 RTF Word PDF 
Employee Separation Checklist (PER-24) 02/2008 Classified Separations
Unclassified Separations
PPM 4950		 RTF Word PDF 
Employment Application   Classified Employment      Online
Employment Eligibility Verification (I-9) 06/2008 Instructions    PDF 
Employment Forms   Employment Services       
Exit Interview for Classified Employees (PER-16) 06/2003 PPM 4950.015 RTF Word PDF 
Exit Interview Letter at Resignation 06/2007 PPM 4950.015     PDF 
Exit Interview Letter at Retirement 06/2007 PPM 4950.015     PDF 
Faculty and GTA Spoken English Competency Assessment Sheet (PER-20) 01/2007 Unclassified
Graduate Student		 RTF Word PDF 
Family and Medical Leave Act (FMLA) Certification of Health Care Provider   Classified PPM 4860.50
Unclassified PPM 4865.60		 RTF Word PDF 
Family and Medical Leave Act (FMLA) Employee Request Form 01/2007 Classified PPM 4860.50
Unclassified PPM 4865.60		 RTF Word PDF 
Family and Medical Leave Act (FMLA) Employer Checklist 01/2007 Classified PPM 4860.50
Unclassified PPM 4865.60		 RTF Word PDF 
Family and Medical Leave Act (FMLA) Notice of Designation of FMLA Leave 01/2007 Classified PPM 4860.50
Unclassified PPM 4865.60		 RTF Word PDF 
Family and Medical Leave Act (FMLA) Notice to Employees Requesting FMLA 5/1999 Classified PPM 4860.50
Unclassified PPM 4865.60		 RTF Word PDF 
KSU Foreign National Tax Information Form (PER-15) 07/2007 Visa Classifications RTF Word PDF 
Form Number Order Forms           
Funding Data Sheet (PER-44) 06/2005 Instructions RTF Word PDF 
Graduate Student Appointment Form (PER-41) 02/2007 Instructions RTF Word PDF 
Graduate Research Assistant/Teaching Assistant Health Insurance 2008/2009 Information     PDF  
Graduate Student Forms   Checklist
Transaction Guidelines		       
GTA Spoken English Remediation Course/Program Approval Request (PER 20A) 01/2007 Included RTF Word PDF  
Health Care Selection Form 06/2003 Health Insurance     PDF  
Health Insurance Affidavit of Common Law Marriage and Request for Enrollment of Common Law Spouse 02/2008 Health Insurance     PDF  
Health Insurance Application for Coverage of Handicapped Dependent Child 02/2008 Health Insurance     PDF  
Health Insurance Claim Form (State of Kansas) 1/1998 Health Insurance     PDF 
Health Insurance Communication Form 02/2008 Health Insurance     PDF 
Health Insurance Dependent Grandchild Affidavit 02/2008 Health Insurance     PDF  
HIPAA- Authorization Form for Release of Medical Information 03/2008 Health Insurance     PDF  
Health Savings Account Enrollment & Change Form 02/2008 Health Insurance     PDF  
Health Savings Account Enrollment Form UMB Bank 02/2007 Health Insurance     PDF  
HealthyKIDS Application   Fact Sheet(pdf)     PDF 
Holiday Emergency Overtime Reporting 6/2003 PPM 4450.70 RTF Word PDF 
Hourly Student Data Sheet (PER-40) 02/2007 Instructions
Information		 RTF Word PDF 
Hourly Student Forms   Checklist
Transaction Guidelines		       
HRIS/PeopleSoft Access Form   Instructions (pdf)
HRIS Roles		 RTF Word PDF 
HRIS Problem Investigation Request Fax Form 11/1996   RTF Word PDF 
Initial Screening of Candidates Prior to Interview (AA-28)   Instructions RTF Word PDF Excel
Intellectual Property Agreement   Information RTF Word PDF  
Investment Agreement - Mandatory Retirement Plan (Kansas Board of Regents) (PER-13) 01/2007 PPM 4810.20 RTF Word PDF  
Investment Agreement - Voluntary Retirement Plan (Kansas Board of Regents) (PER-19) 01/2007 PPM 4810.80 RTF Word PDF  
IT Access Forms  Information Technology    
KanElect Claim Form 1/2004 Flexible Spending Accounts   Word PDF 
KanElect Direct Deposit/E-Mail Notification Form   Flexible Spending Accounts   Word   
Kansas Board of Regents Mandatory Retirement Plan Investment Agreement (PER-13) 01/2007 PPM 4810.20 RTF Word PDF  
Kansas Board of Regents Voluntary Retirement Plan Investment Agreement (PER-19) 01/2007 PPM 4810.80 RTF Word PDF  
Kansas Employee's Withholding Allowance Certificate (K-4) 09/2007 Information     PDF  
Learning Quest Direct Investment Form Information    PDF 
Learning Quest Payroll Deduction Change Form  Information    PDF 
Leave Balance Correction Sheet (PER-9) 5/2001 Information RTF Word PDF 
Leave Forms   Leave Programs       
Leave Record 06/2008
for FY 2009		 Instructions RTF Word PDF Excel
Leave Request-Hourly (Non-Exempt) Employees   Instructions      Online
Leave Request-Salaried (Exempt) Faculty and Staff   Instructions      Online
Leave-Sabbatical Leave Application Form   Guidelines      Online
Life Insurance Beneficiary Designation Form (TEA) 07/2001 Included
TEA Life Insurance		     PDF  
Life Insurance Enrollment Form (TEA)   TEA Life Insurance     PDF 
Life Insurance Request to Change or Cancel Insurance Policy Form (TEA)   TEA Life Insurance     PDF  
Life Insurance Statement of Health (TEA)   TEA Life Insurance    PDF 
Memorandum A - Template for Graduate Assistants Appt for Applicants Not Requiring Background Check Background Checks RTF Word PDF  
Memorandum B - Template for Graduate Assistants Appt for Applicants Requiring Background Check Background Checks RTF Word PDF  
Mid Year Base Salary Increase Form (PER-46) 12/2003 Included RTF Word PDF 
Mileage Reimbursement Form (Workers' Compensation)   Information RTF Word PDF  
New Course Data Sheet 2/2006 Instructions (PDF) RTF Word PDF 
New Employee Orientation Forms Checklist 11/2001 PPM 4070 RTF Word PDF  
9 Month Unclassified Summer Transactions (PER-45) 04/2008 Instructions RTF Word PDF 
Non-Resident Alien Forms   Non-Resident Alien Employment       
Notification of Retirement (PER-37) 1/2002 PPM 4810 RTF Word PDF  
Optional Group Life Enrollment Form   Optional Life     PDF 
Optional Group Life Reduction/Cancellation Form 09/2003 Optional Life     PDF 
Orientation Checklist 12/2007 PPM 4070 RTF Word PDF 
Orientation Forms Checklist 11/2001 PPM 4070 RTF Word PDF  
Overtime Compensation Agreement for Non-Exempt Employees (PER-34) 02/2007 PPM 4220.70 RTF Word PDF  
Paycheck Stop Payment Request (DA-6P) 05/2006 Information   PDF Excel
Payroll Transaction Forms  Paychecks & Payments     
Performance Review Forms  Performance Review System     
Personnel Transaction Forms  Transaction Guidelines & Checklists     
Position Administration Forms            
Position Description (Classified) (DA 281-2 Special) 1/1999 PPM 4210
Position Descriptions Checklist		 RTF Word PDF  
Position Description (Unclassified Professional Positions) (PER-23) 02/2007 Instructions
Position Descriptions Checklist		 RTF Word PDF 
Position Data Sheet (PER-36) 02/2007 Unclassified
Classified		 RTF Word PDF 
Prescription Claim Form   Prescription Drug Program     PDF  
Prescription Drug Program Grievance Form 2/1996 Prescription Drug Program RTF Word PDF  
President's Scholarship Application (PER-32A) 01/2007 PPM 4870.40 RTF Word PDF  
Request for Certified Names (PER-5) 07/2003 Department Recruitment Procedures RTF Word PDF  
Request for International Student On-Campus Work Permit   Work Permits       Online
Report/Labels Request   Reports(Ad hoc) RTF Word PDF  
Retirement Notification (PER-37) 1/2002 PPM 4810 RTF Word PDF  
Retirement Plan Investment Agreement - Mandatory (Kansas Board of Regents) (PER-13) 01/2007 PPM 4810.20 RTF Word PDF  
Retirement Plan Investment Agreement - Voluntary (Kansas Board of Regents) (PER-19) 01/2007 PPM 4810.80 RTF Word PDF  
Savings Bond Payroll Savings Authorization (PER-14) 01/2007 U.S. Savings Bonds RTF Word PDF  
Shared Leave Donation Form 8/2001 Classified PPM 4860.140
Unclassified PPM 4865.140		 RTF Word PDF  
Shared Leave Request Form 10/2007 Classified PPM 4860.140
Unclassified PPM 4865.140		 RTF Word PDF  
Student Application for Human Resources   Student Jobs RTF Word PDF  
Student Employee Performance Review (PER-29) 05/2004 PPM 4720#130 RTF Word PDF  
Substance Abuse Policy Affirmation Form 8/2002 Information RTF Word PDF  
Supplemental Pay Form (PER-8)     RTF Word PDF  
Tax Clearance Information Form for Candidates and New Hires (DA-2004a) 05/2004 Information     PDF  
TEA Life Beneficiary Designation Form 07/2001 Included
TEA Life Insurance		     PDF  
TEA Life Insurance Enrollment Form   TEA Life Insurance     PDF  
TEA Life Insurance Request to Change or Cancel Insurance Policy Form   TEA Life Insurance     PDF  
TEA Life Insurance Statement of Health   TEA Life Insurance     PDF  
Request for
Temporary ID for Foreign Graduate Students or Exchange Visitors (PER-12)		 7/2003 Included RTF Word PDF 
Tuition Assistance Application (PER-32) 05/2007 PPM 4870.30 RTF Word PDF 
Unclassified Faculty & Professional Staff Forms  Checklist
Transaction Guidelines		     
U.S. Savings Bond Payroll Savings Authorization (PER-14) 01/2007 U.S. Savings Bond RTF Word PDF  
Workers' Compensation Accident/Injury Report (PER-17) 02/2007 PPM 4820.100 RTF Word PDF  
Workers' Compensation Mileage Reimbursement Form   Information RTF Word PDF  
Work Permit
Request for International Student On-Campus Work Permit		   Work Permits       Online
W-4 Employee's Withholding Allowance Certificate
OR Update online in Employee Self Service		 2008 Included
Information		     PDF 
Withholding form
Kansas Employee's Withholding Allowance Certificate (K-4)		 09/2007 Information     PDF  
W-5 Earned Income Credit 2008 Included
Information		    PDF 
W-9 Request for Taxpayer Identification Number and Certification 10/2007 Included    PDF