Bloom-Carroll

Local School District

OUR STUDENTS • THEIR FUTURES • OUR FOCUS

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Forms

Enrollment

Records Release

Transportation and Food Service Forms

Reimbursement in Lieu of Transportation Form

Free and Reduced Lunch Application

Medical Forms

Student Accident Insurance Form

Asthma Action Plan Form

Diabetes Management Action Plan Form

Food Allergy Action Plan Form

Medication Authorization Form

Seizure Action Plan Form

High School Forms

OSHAA Physical Form

Flexible Credit Application

College Visitation Form

Letter of Recommendation Request

Medication Authorization

Parking Application

Work Permit Application

Physical Education Waiver Form

CURRENT STUDENT Transcript Request Form

FORMER STUDENT Transcript Request Form

Middle School Forms

PTO Volunteer Request Form

Elementary School Forms

Counselor Referral Form

Employee Pay Request Forms

Professional Development Approval Form

Classroom Coverage Request for Payment

Extra Time Request for Payment

Mileage Reimbursement Request for Payment

Substitute Employee Request for Payment

Supplemental Contract Request for Payment

Tutor-Time Sheet Request for Payment

Fiscal Services Forms

Activity Cash Transmittal Form

Building Cash Transmital Form

Credit Card Purchase Recap Form

Purchase Requisition Form

Budget Purpose Statement Form

Sales Project Potential Form

Payroll Forms

2022-2023 Employee Pay Schedule

New Employee Payroll Packet

Change of Address Form/City Tax Form

Direct Deposit Form

Federal Withholding Form W-4

IT-4: State Withholding Form

Unpaid Leave Request Form

Employee Benefit Notices and Forms

Vision Benefits (VSP)

Health Benefit Plan Effective December 1, 2022

Additional Life Insurance Form

Insurance Rates 2022/2023

Dental Benefit Plan Summary

Healthcare Bluebook

Insurance Enrollment or Change Form

Women's Health and Cancer Rights Act

Health Insurance Marketplace Coverage Options

FMLA Procedures

COVID Vaccination Compliance

CareFactor Mobile App

Medicare Notice

HIPPA Privacy Notice

Mastectomy Notice

Employee Assistance Plan (EAP)

Employee Professional Development Forms

Form 1-Employee Profile and IPDP

Form 2-Workshop Approval

Form 3A-College Coursework Approval

Form 3B-Tuition Reimbusement Request

Form 4A-PDU Pre-Approval

Form 4B-PDU Log

Form 5-IPDP Review

Reciprocity Form

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