Benefits • Staff Forms • Staff Development • Contracts • Evaluation

The following forms are downloadable as PDF files. You must have Adobe Acrobat Reader to open the files. Most computers have this application; if not, you can download Reader at no cost by clicking the icon below:

Forms for District Use

Health Plan Enrollment Forms

BlueCross BlueShield of Vermont enrollment form
Harvard Pilgrim HMO enrollment/change form
Harvard Pilgrim POS enrollment/change form

CBI Information and Forms (Flexible Spending)

Other Forms

Assurant Life and Disability Enrollment Form (After downloading form, you can fill it in onscreen, then print and sign.)
Delta Dental Enrollment/Change Form
Direct Deposit Form (This is a direct deposit form by itself; the Payroll Selection Forms below also include the Direct Deposit Form)

Payroll Selection Form - 21 paydays (Ten-Month Personnel)
Payroll Selection Form - 22 paydays
Electronic Deposit Form Only
Pre-Employment Medical Exam Form
W-4 Form (You can type in this form online before printing)
Vermont W-4 Form
I-9 Verification of Employment (To save paper, print only Page 4 of I-9.)
Salary Reduction Agreement for 403(b) Programs (in Word format)
403(b) Service Providers
Notice of Accidental Injury or Occupational Disease
SAU 70 Employee Address and Name Change Form

Helpful Phone Numbers

Contacts for Voluntary Life Insurance

Link to Staff Development forms