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Staff Forms

Employee Demographic Change Form

ACCESS Services License Reimbursement Form

ACT 48 Forms

Arrest/Conviction Report and Certification Form

Benefits Information

2025

ESPA, Act 93, Non Act 93, Highmark Summary of Benefits

PSEA Highmark Summary of Benefits

Uniform Glossary of Health Coverage and Medical Terms 

2026 Benefits Information Documents

MidwestIU4-TeachersQHDHPGrid-January20261.pdf

MIU4-ESPAGrid-QHDHP-January2026.pdf

MIU4-Grid-ACT93QHDHP-January2026.pdf

HIPAAPrivacyNotice-01-01-20261.pdf

Child Abuse

Staff Procedures for Childline Reports Under 18

Employment Clearance Forms

Child Abuse History Certification Form

Request for Criminal Record Form

Family Medical Leave (FMLA) Forms

Board Policy for Family and Medical Leaves

Family Medical Leave Rights & Responsibilities

Interpreter Data Forms

Life Insurance Forms

Medical Notices/Forms

CHIP

HR Memo on PPACA, Mental Health Parity Act, Michelle's Law and CHIP (8.2010)

Mental Health Parity

Michelle's Law

Michelle's Law Continuation of Coverage Form

PPACA Employee Notice

School Personnel Health Record

Procurement Card Monthly Transaction Summary

Paraprofessional Data Forms

Design and Print Center Order Form

Right to Know Request Form

PA Right to Know Law

Right to Know Request Form

Staff Travel Forms

2026: MIU IV Travel Voucher

2025: MIU IV Travel Voucher

Travel Request Form

Tuition Reimbursement Rules & Forms

Tuition Reimbursement Rules & Regulations Act 93 Non Bargaining Unit

Tuition Reimbursement PSEA

ACCESS Services License Reimbursement

Workers' Compensation Information and Forms

 
 

403b Plan Forms

403 b PenServ Plan Guide

403 b Universal Notifcation

Timesheet Forms