Faculty and Staff

Employee Forms

Continuing Education Form File updated: January 9, 2025

Extended Leave Request Form File updated: September 13, 2023

Federal Withholding Form W-4 File updated: January 14, 2026

Field Trip Forms File updated: September 13, 2023

Indiana Withholding Form WH-4 File updated: January 10, 2025

Paid Leave Form File updated: January 27, 2025

Payroll Direct Deposit Authorization Form File updated: March 27, 2025

Sick Bank Usage Request Form File updated: October 10, 2025

Timesheet File updated: January 10, 2025

Travel Request Form File updated: September 13, 2023

Vehicle Request Form File updated: January 7, 2025

Anthem Application File updated: October 30, 2024

Anthem CERTIFIED File updated: November 17, 2025

Anthem CLASSIFIED File updated: November 17, 2025

Dental Benefit Summary File updated: January 5, 2026

HSA 1 Plan Summary File updated: November 17, 2025

HSA 2 Plan Summary File updated: November 17, 2025

PPO Plan Summary File updated: November 17, 2025

Preventative Drug List File updated: January 7, 2026

SISIT Employee Benefits Summary File updated: November 17, 2025

Vision Benefit Summary File updated: November 17, 2025

Vision Insurance Enrollment Form File updated: February 4, 2026

(800) 345-2460 for questions or issues. If not resolved, then please call Todd Nobbe at the administration building.

To link to the Machine-Readable Files, please click on the URL provided:

John Kitlinski – (812) 212-5779 – john.kitlinski@corebridgefinancial.com
Ryan Brown – (765) 620-6433 – ryan.brown@corebridgefinancial.com

(317) 871-2480 or (800) 638-4268, ext 207

PreventiveRX Drug List File updated: January 21, 2025

Teacher Evaluation Plan File updated: November 17, 2025

2025-26 Master Contract File updated: November 20, 2025

Superintendent Contract File updated: May 18, 2026

Classified Staff Compensation and Benefits Package File updated: February 25, 2026

Families First Coronavirus Response Act (FFCRA) File updated: September 13, 2023