University Benefit Appeal Request

Form fields with an asterisk (*) are required fields. If you have questions about the appeals process, please contact Human Resources. if you are a Vanderbilt University Medical Center employee, please complete the Medical Center Benefit Appeal Request Form.

Name Name First Last
Employee ID (Person Number)
Must be 7 characters. Currently Entered: 0 characters.
You can find your employee ID by logging into Oracle (https://oraclecloud.vanderbilt.edu/) select the Personal Details tile then select the Employment Info tile. Scroll down to Person Number.
How often are you paid?

How often are you paid? Weekly Biweekly Monthly
Your Vanderbilt Email Address
Other email address
Day phone number Day phone number - ### - ### ####
Alternate phone number Alternate phone number - ### - ### ####
Your home mailing address Your home mailing address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Why are you submitting an appeal?

Please describe in detail the circumstances. You are encouraged to provide complete and accurate information so that every consideration may be given for the appeal.
Reason for appeal
Optional: upload documentation for your appeal.

Attach Files
By submitting this form, I understand that I am submitting official information to receive benefits coverage. This form is not meant to replace the Summary Plan Descriptions, which are the governing documents for Vanderbilt benefits. Summary Plan Descriptions are available at hr.vanderbilt.edu/benefits/sbc-eoc.php. Offerings and plans are subject to change.

University Benefit Appeal Request

University Benefit Appeal Request

Why are you submitting an appeal?