1104 Forms

The following online forms pertain to members within the Telecommunications and Operator Services Division. Education Division members can retrieve forms at cwa1104gseu.com

Below are all the optical, dental and medical forms you need. Just click on the form you need and print it out and bring it with you to the service provider.

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Due to the popularity of The Work & Family programs, we no longer have a surplus of funds. The Company is required to fund the programs. Health & Wellness (GYM) are being evaluated and MAY go to a yearly reimbursement. DCRF and Summer camp reimbursement has decreased slightly. All other programs are under review.

Dependent Care Reimbursement Fund

Health & Wellness Program Flyer - Coming Soon

Defensive Driving Program - Coming Soon

2024 Work and Family Initiatives - Coming Soon

High School Driver Education - Coming Soon

Summer Camp Flyer

Download

Request for Dependent Care Reimbursement

Download

Dependent Care Reimbursement Fund Application

Download

Tutoring Program Reimbursement Program - Coming Soon

College Book Reimbursement - Coming Soon

Pendant Quarterly Reimbursement

Download

Pendant Application

Download

Summer Camp Application

Download

Dental/Vision

Davis Vision Claim Form

Download

Dental Expense Claim Form

Download

Disability

Sedgwick Form

Download

Sedgwick Authorization To Disclose Info

Download

F.M.L.A.

Download

Verizon claim form Empire Blue Cross Blue Shield

Download