- 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
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Summary of Benefits-QHDHP
SBC NGF Midwestern IU 4 112022 176960001020310117072.pdf 618.99 KB (Last Modified on Monday at 2:58 PM) -
Uniform Glossary
Uniform Glossary of Health Coverage and Medical Terms - Effective Jan 1 2021.pdf 123.08 KB (Last Modified on Monday at 2:54 PM)
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)
Paraprofessional Data Forms
Right to Know Request Form
Staff Travel Forms
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