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

Download

2025 Work and Family Initiatives

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Dependent Care Reimbursement Fund Application and Q & A

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Dependent Care Reimbursement Fund Application

Download

Educational Reimbursement Program

Download

Pendant Quarterly Reimbursement

Download

Pendant Application

Download

Summer Camp Application

Download

Dental/Vision

Dental Expense Claim Form

Download

Davis Vision Claim Form

Download

Disability

F.M.L.A.

Download

Verizon claim form Empire Blue Cross Blue Shield

Download

Sedgwick Form

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Sedgwick Authorization To Disclose Info

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