Employee Forms
Continuing Education Form
File updated: May 22, 2023
Extended Leave Request Form
File updated: August 11, 2022
Federal Withholding Form W-4
File updated: January 24, 2023
Field Trip Forms
File updated: May 5, 2022
Indiana Withholding Form WH-4
File updated: January 24, 2023
Paid Leave Form
File updated: March 25, 2022
Payroll Direct Deposit Authorization Form
File updated: January 11, 2022
Timesheet
File updated: May 5, 2022
Travel Request Form
File updated: January 11, 2022
Vehicle Request Form
File updated: May 5, 2022
Doc Delivery
Benefits
Anthem Application
File updated: July 1, 2022
Anthem CERTIFIED
File updated: November 29, 2022
Anthem CLASSIFIED
File updated: November 29, 2022
HSA 1 Plan Summary
File updated: April 26, 2022
HSA 2 Plan Summary
File updated: April 26, 2022
PPO Plan Summary
File updated: April 26, 2022
Pre-Dent Dental Benefits
File updated: April 26, 2022
SISIT Benefits
File updated: January 2, 2023
Valic - Section 403(b) Salary Reduction Agreement
File updated: August 15, 2022
Vision Benefit Summary
File updated: April 26, 2022
Vision Insurance Enrollment Form
File updated: July 12, 2022
Anthem
(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:
Valic
John Kitlinski – (812) 212-5779 – john.kitlinski@valic.com
Ryan Brown – (765) 620-6433 – ryan.brown@valic.com
American Fidelity
(317) 871-2480 or (800) 638-4268, ext 207
Current Clinic Providers
Labs List
File updated: January 2, 2023
PreventiveRX Drug List
File updated: January 26, 2023
Teacher Evaluation Plan
Teacher Evaluation Plan
File updated: January 6, 2022
Contracts
Master Contract
File updated: January 6, 2022
Superintendent Contract
File updated: January 6, 2022
Classified Employees
Classified Staff Compensation and Benefits Package
File updated: May 23, 2023
Additional Resources
Families First Coronavirus Response Act (FFCRA)
File updated: April 26, 2022