- Midwestern Intermediate Unit IV
- Staff Forms
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Click on the blue bar below to view of list of staff forms that fit in the listed category.
Employee Incentive Form
Staff Address Change & Name Change Forms
ACT 48 Forms
Arrest/Conviction Report and Certification Form
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Arrest/Conviction Report and Certification Form
Arrest or Conviction Report and Certification Form.pdf 119.60 KB (Last Modified on December 10, 2014)
Benefits Information
Child Abuse
Employment Clearance Forms
Family Medical Leave (FMLA) Forms
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Family Medical Leave Rights & Responsibilities
All employees should contact Brenda A. Marino, Esq., Director of Human Resources, for all requests for Family Medical Leave. -
FMLA Board Policy for Administrative
Family Medical Leave Board Policy for Administrative Employees.pdf 7.19 MB (Last Modified on December 14, 2014) -
FMLA Board Policy for Professional Employees
Family Medical Leave Board Policy for Professional Employees.pdf 7.31 MB (Last Modified on December 14, 2014) -
FMLA Board Policy for Support Staff
Family Medical Leave Board Policy for Support Staff.pdf 7.18 MB (Last Modified on December 14, 2014)
Interpreter Data Forms
Life Insurance Forms
Medical Notices/Forms
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Michelle's Law Continuation of Coverage Form
Michelles Law Form Continuation of Coverage Form _2_.pdf 78.70 KB (Last Modified on December 14, 2014)
Procurement Card Monthly Transaction Summary
Paraprofessional Data Forms
Right to Know Request Form
Staff Travel Forms
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July 1 2022-December 31 2022 Travel Voucher
BLANK_July_1_2022-December_31_2022_Travel_Voucher_Revised 7.22.xlsx 19.24 KB (Last Modified on August 26, 2022)
Tuition Reimbursement Rules & Forms
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Tuition Reimbursement Rules & Regulations Act 93 Non Bargaining Unit
Tuition Reimbursement Rules and Regulations ACT 93 and NBU.docx 24.53 KB (Last Modified on December 14, 2014) -
ACCESS Services License Reimbursement
2017 - 2022 ACCESS Services License Reimbursement Form.pdf 117.87 KB (Last Modified on September 28, 2018)
Workers' Compensation Information and Forms
403b Plan Forms
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403 b Universal Notifcation
2015 Universal Availability Notification Midwestern Intermediate Unit 4.pdf 59.11 KB (Last Modified on January 20, 2015)
Timesheet Forms
Contacts
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Brenda A. Marino, Esq.
Assistant to the Executive Director
724-458-6700 x1204Donna Volpe,
Executive Secretary
724-458-6700 ext. 1203