Resident and Fellow Forms

UT Tax Deferred Income Plans

Although Residents and Fellows are "Special Employees" who are not eligible for regular state retirement, UT offers several tax-deferred income plans in which you can participate:  401(k), 403(b), and 457 Plans. As a Special Employee, you are not eligible for matching funds in the 401(k) plan.   

For information about these plans, please visit the UTHSC Benefits website at the UTHSC Human Resources Benefits website.   You will find links about forms and providers on that website.  You may also contact Allan Landstreet, CFP/Retirement Plan Counselor with Empower Retirement in Memphis via email at allan.landstreet@empower-retirement.com or via his cell phone at 901.550.4549.

If you decide to set up tax deferred income plans through the University, please complete the forms and then bring your completed forms to Jacqueline Hogan in the GME Office (Whitehall Building) for processing.

Other Resident/Fellow Forms

UT Payroll Forms

• W-4 Form
• UTHSC FMLA Rights and Responsibilities
• UTHSC FMLA Request Form
• UTHSC Direct Deposit Form

Resident/Fellow Time Off Reporting

• 255-Procedure for Reporting Resident Time Off
• 256-Form for Reporting Resident Time Off with built-in formula 

Off-site Elective Rotations

• Requests for Off-site Elective Rotations 
  Off-site elective rotations may be approved on a case-by-case basis; however, each must be considered individually and must be approved by our Program Director, DIO and Dean, as well as the Erlanger CEO.  Residents requesting off-site electives must understand that there are no UT funds available for housing or travel unless the rotation is required by the program.  Preference would be given to a rotation on another UT Campus.  The Resident License Exemption from the Tennessee Board of Medical Examiners is issued annually and only covers trainees who are rotating with Tennessee.  Residents rotating within Tennessee have immunity from professional liability via the Tennessee State Claims Commission Act.  If a rotation is approved at Vanderbilt University in Tennessee, the Resident/Fellow will be responsible for securing malpractice insurance including all associated costs for the insurance.  Vanderbilt does not recognize the limits of the State Claims Commission Act providing immunity for UT Residents.  Also, if the rotation occurs outside Tennessee, the Resident/Fellow will be responsible for securing a medical license or training license in that state and malpractice insurance and any associated costs.

For any other forms, such as travel and professional development reimbursement, please contact your Coordinator and Jacqueline Hogan, GME Financial Specialist at 423.778.3899 (jacqueline.hogan@erlanger.org); Robbin Williams, C-TAGME, GME Lead Coordinator, at 423.778.3894 (robbin.williams@erlanger.org); or Pamela Scott, C-TAGME, Director for Graduate & Medical Student Education at 423.778.7442 (Pam.Scott@erlanger.org).