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    Forms Icon     Click on the form name below to download the form you need.
     
    End of Year Employee Information  Letter
    2023 W4
    Change of Address/Phone
    Direct Deposit
    FRINGE BENEFIT PACKET
    MASTER Health/Dental Enrollment-Change Form
    HSA CONTRIBUTION ELECTION FORM 2023
    Life Insurance Enrollment Form
    Beneficiary Tips Flyer
    Benefit Election Form
     
     
    Act 48 LOG 
    Expense Voucher
    Reimbursement Form
    Personal Day Form
    Bereavement Day Request
    UNCOMPENSATED LEAVE-FORM/POLICY
    Verification of Compensatory Trade Time
    Release Time Request-Professional Development
    Release Time Request-Staff and Student Travel
    Requisition Form
    Vehicle Use Approval Form
     
    Graduate Credit Reimbursement Form
    Graduate Credit Pre-approval Form
     
    Timesheet-Admin Absence Report
    Timesheet-District
    Timesheet-Homebound Instruction (2 pages)
     Class Coverage Form HS 2019
    Class Coverage Form MS 2019
    Class Coverage Form ES 2019
     
     
    Applicant Approval Form
    PA Standard Application
    District Support/Extra-Curricular Application
     
     
    Application Attachment
     
     
    Required Clearances Info
    PDE-Act 114 FBI Fingerprint Requirements
    PDE Act 114 Service Code
    PDE Act 151 PA Child Abuse History Requirements
    PDE Act 34 PA State Criminal History Requirements
    Act 126 Mandated Reporter Training Information
    Act 168 Disclosure Release Form
    Act 24 Arrest and Conviction Report
    Local Wage Tax Residency Certification
     IT New Employee Profile Form
    PAYROLL PACKET
     
    2023 Universal Availability Notice
    OMNI 403B INFORMATION
     
    AFLAC INFORMATION
     
    ONE AMERICA EMPLOYEE ASSISTANCE PROGRAM (EAP)
     
    Delta Dental-Enrollee Notices
    Delta Dental Highlight Sheet
    Delta Dental Benefit Booklet
     Delta Dental SBC
     
     Uniform Glossary-Health Terms
    Highmark PPO Blue Benefit Book
    Consolidated Appropriations Act Transparency In Coverage
    Care Cost Estimator
    Summary of Benefit Coverage
    Highmark BCBS Preventative Maintainence Schedule
    Blues On Call Brochure
     
    Swift MD Flyer
     
    HSA Eligible Expense Listing
    HSA Account User Guide
    QHDHP and HSA FAQ's
    QHDHP Presentation
     
    WC PANEL-EE Duties
    WC Injury Kit  
    WC-Decline Treatment Kit
     WC-Claim Reporting Instruction-SUPERVISORS
     
    FMLA Request & Healthcare Prov Certification-EMPLOYEE
    FMLA Request & Healthcare Prov Certification-FAMILY MEMBER 
     
    Age 26 Coverage Update
    HIPAA Privacy Notice
    HIPAA Special Enrollment Notice
    Newborn & Mother Health Protection Act
    Women's HCRA
    Credible Coverage
     Health Parity
    CHIP Notice
     
    Safety Committee By-Laws
    Safety Concern Reporting Form
     
    Acceptable Use of Technology
     
    Student Activity-Cash Advance and Reconciliation Forms
    Student Activity- Deposit Settlement Sheet
    Student Activity-Sponsor Annual Report
    Student Activity-Fundraising Project Form
    Student Activity-Invoice Requisition Form
    Student Activity-Reimbursement Request
    Student Activity Account-Signature Card Form
    Student Activity Account-Manual and Forms
     
    LST-exemption.pdf
    LST-refund form

     

Freedom Area School District

1702 School Street, Freedom, PA 15042

724-775-5464 724-775-7434

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