Forms

• Agreement for Contracted Services
   
• W-9 Form
   
• Charter Invoice Form
   
• Monthly Mileage Expense Claim
   
• Mileage Chart
   
• Request for Out-Of-Pocket Reimbursement
   
• Open Purchase Order Payment Request

• Purchase Requisition
   
• Request for Change to Purchase Order

• Vendor Instructions

• Direct Deposit Authorization Agreement
• Employee Monthly Absence Report
• Substitute Time Sheet
• Instructional Time Sheet
• Non-Instructional Time Sheet
• State Employee's Withholding Allowance (DE4)
• Federal Employee's Withholding Allowance (W-4)
• W-2 Replacement Request Form
• 2022-23 Semi-Monthly Time Sheet Deadlines

403(b) Tax Shelter Annuity

If you are interested in setting up a 403(b) or would like to make changes to your existing 403(b), please click on the link below for instructions to make changes to the CalSTRS403bComply website.  

• 403(b) Sign Up & Changes 

457 Deferred Compensation

If you are interested in setting up a 457 Deferred Compensation Account, please click on the link below to complete the form and return it to the Business Office.

• CalPERS Supplemental Income Plan 457
  • Plan 457 Beneficiary Form 

• Absence and Substitute Request
   
• Employee Name and Address Change
   
• Employee Checkout
   
• Employee Request for Family/Medical Leave
   
• Insurance Cancellation
• Fingerprint Request
• Benefit Selection Form

• CharterLIFE Declination Form

Medical - CharterLIFE

• Anthem Enrollment Form
  • Anthem Blue Cross High EPO Plan Summary
  • Anthem Blue Cross Low EPO Plan Summary
  • Anthem Blue Cross Base EPO 
  • Anthem Blue Cross Base PPO HDP Summary
• Kaiser Enrollment Form
  • Kaiser HMO High Plan Summary
  • Kaiser HMO Low Plan Summary
  • Kaiser HMO $1500 HMO HDP Plan Summary
  • New Kaiser Specialty Drug Plan Charges (applies to all Kaiser Plans)
  • Kaiser Chiropractic Benefits

Dental and Vision - SIA

• Delta Dental Enrollment Form
  • Delta Dental Plan Summary
  • How to Print an ID Card for Delta Dental
• Vision Services Plan (VSP) Enrollment Form
  • VSP Benefit Summary

Voluntary Deductions

• Section 125 Plans
  • American Fidelity Section 125 Plan Information
• American Fidelity misc. optional insurance information and products
  • American Fidelity rep and contact information
• AFLAC misc. optional insurance information and products
  • AFLAC rep and contact information

Additional Benefits (free of charge)

• NCS Group Life Insurance
  • Hartford Life (free NCS group plan)
• CharterLIFE Wellness Program
• NCS Retiree Group Benefit Coverage Policy
• Employee Assistance Programs (EAP) 
  • MHN through SIA EAP
  • Hartford Life EAP

Other Information

• Affordable Care Act (ACA) and Covered California
  • ACA FAQs
  • Covered California
  • HealthCare.gov
  • New Health Insurance Marketplace Coverage Options & Your Health Coverage

Administrative

Management and Supervisory

Executive

Instructional

Non-Instructional

Substitutes & Hourly

School Psychologist 

Speech & Language Pathologist 

Instructional Stipend Addendum

 

• Cash & Check Log
• Billing Request
• Cash Count Form (ASB/Booster Club)