• Personal Information Change Form - If you do not have insurance benefits through NSCC, use this form to report any changes to your personal information.
• Federal Tax Form W-4  Submit directly to Business Office
• Ohio State Tax Form - Submit directly to Business Office
• Indiana State Tax Form - Submit directly to Business Office
• Michigan State Tax Form -Submit directly to Business Office
• City Tax Form  Submit directly to Business Office
• Direct Deposit  Form Submit directly to Business Office
• Personal Information Change Form for those with Insurance - Use this form to report any changes to your personal information.  A copy will be sent to NBEC to provide the new information to the insurance companies.
• Medical Insurance Change Form
• Medical COB Form - Complete only if dual coverage is applicable.
• Prescription Insurance Change Form
• Dental Insurance Change Form
• Dental COB Form - Complete only if dual coverage is applicable.
• Full-Time Faculty Basic Life Insurance Change Form
• Support Staff Basic Life Insurance Change Form
• Graded Employee Basic Life Insurance Change Form
• Vision Insurance Change Form
• Full-Time Student Verification Form
• Out of Area Waiver Form
• Flexible Spending Claim Form

Northwest State Community College is a member of the Northern Buckeye Education Council (NBEC), a consortium of Educational institutions and organizations. The purpose of the NBEC is to provide educational entities in greater northwestern Ohio access to a variety of cooperative administrative services thereby reducing the cost of obtaining these services. Currently NSCC’s basic life, dental and health insurance benefit programs are managed through NBEC.

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• Medical/Prescription
• SPD
• Network Information – You can quickly and easily search for participating facilities and physicians on the frontpath web site by visiting, www.frontpathcoalition.com
• Medical Enrollment/Change Form
• Medical COB Form - Complete only if dual coverage is applicable.
• Prescription Enrollment/Change Form
• Instructions on accessing the AAG website
  • AAG Online
• Instructions on accessing the Express Scripts website
  • Express Scripts Online

• Dental
• SPD
• Dental Enrollment/Change Form
• Dental COB Form - Complete only if dual coverage is applicable.
• Instructions on accessing the AAG website
  • AAG Online Information
• Life
  • Full-Time Faculty Basic Life Insurance Change Form
  • Support Staff Basic Life Insurance Change Form
  • Graded Employee Basic Life Insurance Change Form
• Vision
• SPD
• Vision Enrollment/Change Form
• VSP 1-800-877-7195
  • VSP Online Information
• American Fidelity - Flexible Spending and Supplemental Insurance
• Flexible Spending Account claim form
• Contact Information 1-877-518-2337
  • For more information, go to www.afadvantage.com
• Employee Assistance Program
• Symmetry offers private, confidential counseling sessions.  To schedule an appointment or for more information, call 1-800-422-5338 or visit www.4symmetry.org