Forms

A National School District of Character

CLASSIFIED STAFF FORMS

Classified Staff Leave Information (please email completed form to [email protected])

Classified Staff Leave Form - FMLA/Medical/Maternity/Adoption/Child Rearing Leave Form

Miscellaneous

Act 168 Form Sexual Misconduct Abuse/Disclosure Release

Support Staff Employment Application

Interest Form for a Posted Support Position

Classified Staff Tuition Reimbursement Form

Professional Staff Forms

Teachers and Administrators

Coursework Approval Information/Application Forms (please email completed form to [email protected])

Certified Staff Application for Approval of Courses

Certified Staff Tuition Reimbursement Application

Application for Salary Credit for Professional Courses

List of PDE Approved Institutions

Universities and Institutions - Not Approved

Certified Staff Leave Forms (please email completed form to [email protected])

PSD Medical/Disability/Maternity/Adoption/Child Rearing Leave Form

Education and Professional Development Sabbatical Request Form

Request for Sabbatical for Restoration of Health

Miscellaneous

PenServ Online 403B Plan - Enrollment & Web Access Guide

Act 168 Form - Sexual Misconduct Abuse/Disclosure Release

NEW HIRE PAPERWORK

Professional Staff - New Hire Required Paperwork

Classified Staff - New Hire Required Paperwork

Substitute Staff - New Hire Paperwork

Athletic Supplemental - New Hire Paperwork

Change of Address

Change of Address or Name - Print and Complete the following forms.

Once forms are complete, return them to the Human Resources Department.

Employee Status Form
Print and complete top portion of Section A only.

Local Earned Income Tax Residency Certification Form

Print and complete Employee Information section at the top of the form as well as the Certification at the bottom.

Benefit Forms

Certified Staff Enrollment Form 2021 - 2022

Certified Staff Waiver of Benefits Form 2021 - 2022

Support Staff Enrollment Form 26 Pays 2021 - 2022

Support Staff Enrollment Form 21 Pays 2021 - 2022

Support Staff Waiver of Benefits 2021 - 2022

Confidential Exempt Enrollment Form 2021 - 2022

Confidential Exempt Waiver Form 2021 - 2022

Retiree Certified Cobra Enrollment Form 2021 - 2022

Retiree Support Staff Cobra Enrollment Form 2021 - 2022

Certified Cobra Continuation of Coverage Election Form 2021 - 2022

Support Staff Cobra Continuation of Coverage Election Form 2021 - 2022

Life Insurance Beneficiary Form

Long Term Disability Information and Enrollment Form

Continued Coverage for Handicapped Child

Prescription Mail In Form

Creditable Coverage

Claim Forms

United Group Flexible Spending Claim Form

Flexible Spending Account Benefits

Optimed Flexible Spending Plan Consumer Portal Quick Start Guide

United Concordia Claim Form

Delta Dental Claim Form

Long Term Disability Claim Information

Influenza Vaccine Reimbursement Form

Out of Network Claim Form - Personal Choice

Certified Staff Vision Reimbursement Form

Pennsbury School District
134 Yardley Avenue, PO Box 338
Fallsington, PA 19058
Telephone: 215-428-4100

Mission Statement
Recognizing our proud traditions and diverse community,
the Pennsbury School District prepares all students to become creative,
ethical, and critical thinkers for lifelong success in a global society.

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