Family Support Services

Title
A short description to explain the nature of a ticket.
Use this form to securely submit documentation and request assistance related to an employee’s passing, including benefit and payroll-related matters.
First and Last Name
Please enter your contact information
Enter the name of the individual submitting this request

The EAP is available to support employees and family members affected by a loss. Services and resources include bereavement support groups, individual grief counseling, and assistance with other related needs. All services are confidential.  Please indicate Yes or No in the drop down if you would like to be connected with the EAP Coordinator.

Please indicate if you would like to be connected with our EAP area for assistance
What current documents, procedures, workflows, and guidelines are available to support the training? Does policies, guidelines, procedures, or protocols need to be created or modified?
Please upload any supporting documents related to the employee’s passing, for example, copy of the death certificate and completed Next Of Kin Affadavit 
File attachments associated with the ticket.
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Enter Employee's Date of Death
Enter Department HRBP name

Other Fields

Your name
Verification Code