Forms

A National School District of Character

Human Resources

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Human Resources

Classified Staff Forms

Support Staff Employment Application

Interest Form for a Posted Support Position

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

Act 168 Form Sexual Misconduct Abuse/Disclosure Release

Classified Staff - New Hire Required Paperwork

Substitute Staff - New Hire Paperwork

Athletic Supplemental - New Hire Paperwork

Professional Staff Forms

Teachers and Administrators

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 Vision Reimbursement Claim Form

Education and Professional Development Sabbatical Request Form
Request for Sabbatical for Restoration of Health

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

PenServ Online 403B Plan - Enrollment & Web Access Guide

Act 168 Form - Sexual Misconduct Abuse/Disclosure Release

Professional Staff - New Hire Required 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

2019-2020 Certified Staff Enrollment Form

2019-2020 Waiver of Insurance Form - Certified Staff

2019-2020 Support Staff Enrollment Form - 26 pays

2019-2020 Support Staff Enrollment Form - 21 pays

2019-2020 Waiver of Insurance Form - Support Staff

Life Insurance Beneficiary Form

2019-2020 Cobra Continuation of Coverage Enrollment Form - Certified Staff

2019-2020 Cobra Continuation of Coverage Enrollment Form - Support Staff

2019-2020 Retiree Cobra Enrollment Form - Certified Staff

2019-2020 Retiree Cobra Enrollment Form - Support Staff

Continued Coverage for Handicapped Child

Prescription Mail In Form

Creditable Coverage

Workman's Compensation Report Form and Information

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

Prescription Reimbursement Form

Influenza Vaccine Reimbursement Form

Long Term Disability claim form

Disability Insurance Enrollment Form

Out of Network Claim Form - Personal Choice

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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