Important Forms

 403B Tax Sheltered Account Program 2019-2020.pdf 

Accident Incident or Injury Report.pdf  

Additional Work Duty Form.pdf  

Athletic Contest Workers Form.pdf  

 Blank Check Request.pdf 

 Copy of Blank Requistion Sheet.xls 

BUDGET CODE LIST 13-14.xls  

 Election of Health Insurance Withdrawl-Buyout-AFSCME.pdf 

 Election of Health Insurance Withdrawl-Buyout-Teachers.pdf 

 CHIP Notice.pdf 

 Daily Conference Request 2019.docx 

Dependent Coverage to Age 26 Notice 4.pdf  

Direct Deposit Form.pdf  Direct Deposit.pdf  

 Field Trip Form 2019-2020.pdf 

 Final Accounting Expense Sheet 2019.doc 

 FMLA Employee Form.pdf 

 FMLA Family Member Form.pdf 

Guidelines for Public Comment 1.pdf 

 Employee Healthcare Selection Letter.pdf 

 Employee Healthcare Enrollment Form.pdf 

 Health Insurance Market Place Notice.pdf 

 Health Insurance Withdrawl-Buyout Form.pdf 

 HIPAA Notice of Privacy Practices.pdf 

 Notice of HIPAA Special Enrollment Rights.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 Form 2019.xlsx 

NVA - Yough Benefit Summary.pdf 

NVA Claim Form.pdf 

Newborns and Mothers Health Protection Act.pdf 

Overnight Conference Request Form 2019.doc 

Patient Protection Disclosure.pdf 

Physicians Certificate for Medication.pdf 

 Reg Employee Time Sheet.pdf  

Sabbatical Leave Form.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.docx 

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