Important Forms

 2021 403 b Summary Plan Description Plan 457.pdf 

Accident Incident or Injury Report.pdf  

Additional Work Duty Form.pdf  

Athletic Contest Workers Form.pdf  

 Blank Check Request.pdf 

 Blank Requisition Sheet 2020-2021.xls 

 Election of Health Insurance Withdrawal Buyout AFSCME.pdf 

 Election of Health Insurance Withdrawal Buyout TEACHERS.pdf 

 Election of Health Insurance Withdrawal Butout ADMIN.pdf 

 CHIP Model Notice.pdf 

 Daily Conference Request 2021.docx 

Dependent Coverage to Age 26 Notice 4.pdf  

 Direct Deposit Form 2021.pdf 

 Field Trip Form 2019-2020.pdf 

 Final Accounting Expense Sheet 2021.doc 

 FMLA Form Employee.pdf 

 FMLA Form Family Member.pdf 

Guidelines for Public Comment 1.pdf 

 Health Insurance Letter 2021-22.pdf 

 Employee Healthcare Selection Form 2021-22 ALL.pdf 

 Marketplace Model Notice Health Care 6-30-2023.pdf 

 Health Insurance Withdrawl-Buyout Form.pdf 

 Notice of HIPAA Privacy Practices.pdf 

 Nondiscrimination Notice ACA Section 1557.pdf 

 Notice of HIPAA Special Enrollment Rights.pdf 

 Highmark Preventive Care Schedule 2021.pdf 

Highmark Website Navigation.pdf

Home Language Survey.pdf 

Homebound Instruction.pdf  

Homebound Teaching Report.pdf 

 Human Resources Tracking Form.pdf 


 Mentor Report Form.pdf  


KM_Salary Reduction Agreement for 403revised.pdf  

 Mental Health Parity Act.pdf 

 Mileage Reimbursement Form2021.xlsx 

NVA - Yough Benefit Summary.pdf 

NVA Claim Form.pdf 

Newborns and Mothers Health Protection Act.pdf 

 Overnight Conference Request 2021.doc 

Patient Protection Disclosure.pdf 

 P Card Support Form 20-21.pdf 

Physicians Certificate for Medication.pdf 

Reg Employee Time Sheet.pdf  

Sabbatical Leave Form.pdf  

 Sick Day Bonus 2020-21.pdf 

 School Personnel Health Record Form 2019.pdf 

Sub Time Sheet.pdf  

 Summary of Benefits - Plan A.pdf 

 Summary of Benefits - Plan E.pdf 

 Summary of Benefits - Plan G.pdf 

 Tuition Reimbursement Packet.pdf 

United Concordia Dental Coverage Information.pdf  

 UPMC Westmoreland Broad Access - FAQs.pdf 

 UPMC Westmoreland Broad Access Grid.pdf 

Voya Financial.pdf  WHCRA Notice 1.docx  

 Womens Health and Cancer Rights Act.pdf 

WS707 Use of Fac.pdf  

WSUse of Facility2014.pdf   

Identogo Instructions.pdf