Benefits Forms

Assure Card Claim Form

Submit this form for prescription drug claims.

Dental Claim Form

Health Care Partnership

Health Care Partnership: Pharmacy List

Healthcare Expenses Statement

This form is used for extended health claims (including eye exams) covered under your plan

Out of Country Authorization and Release Form

Submit this and the 'Out of Country Claim Form' to claim out-of-country medical expenses

Out of Country Claim Form

Submit this and the 'Out of Country Authorization and Release Form' to claim out-of-country medical expenses

Visioncare Claim Form

Beneficiary Nomination Form

Change your beneficiaries for Group Life Insurance

Evidence of Insurability

This form is used in addition to the Group Coverage Change form when you are a late applicant for health, dental, or optional life insurance, or when you want to increase your optional life insurance

Group Coverage Change Form

This form is used to submit a change (i.e. additional of spousal/dependent information) to your Group Coverage with Canada Life. Please sign and submit to a Benefits Specialist.

Optional Life Insurance – Trustee Appointment Form

Assign a trustee for optional life insurance when your beneficiary is a minor or lacks legal capacity. Return to the Benefits Specialist when complete.

Contract Instructor Tuition Waiver

Application to waive tuition fees for Contract Instructors

Tuition Waiver Application (Online Submission)

The online submission form is published on Carleton's intranet and can only be accessed by current employees

Tuition Waiver Application (PDF)

Note: Open this file in a PDF viewer (Adobe/Foxit) to access the digital signature feature.

Career Development Fund Application Form

The Career Development Fund is available to assist employees who wish to pursue training associated with career development objectives.

Early Payment Application

Completion of the Early Payment Application is required for Career Development Fund participants who wish to be reimbursed at the beginning, rather than at the end of their program.