Document Upload for Multi-District Part-Time Faculty Health Insurance Reimbursement Request

This form is for qualifying faculty who are eligible to participate in the Multi-District Part-Time Faculty Health Insurance Reimbursement Program and have already submitted the online request form but have not yet submitted documentation. The deadline to submit documentation is:

• 11:59 pm on September 2 for the fall semester (or the next available business day, if this date falls on a weekend or holiday).
• 11:59 pm on February 10 for the spring semester (or the next available business day, if this date falls on a weekend or holiday).