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Faculty/Staff Forms:

 

Intent to Take Leave Form Use this form if you plan to take an extended leave of absence
Health Examiniation Form  Use this form when you get a physical for the DUFSD
Salary Adjustment Form Use this form when you are requesting a Educational Credit Salary Adjustment
Cancer Screening Form for Nurses, Teacher Aides, Monitors, Custodial, Clerical, & Kitchen Employees

Use this form when you take leave for cancer screening

READ SPECIFICS TO THE LEFT!!!

Cancer Screening Form for Administrators, Teachers and Teaching Assistants

Use this form when you take leave for cancer screening

READ SPECIFICS TO THE LEFT!!!

Teachers of Tomorrow Use this form to apply for the Teachers of Tomorrow Grant
Budget Transfer Form For administrators' use only
Payment Voucher Use to request payment from the DUFSD for items other than payroll (Examples: Reimbursement for mileage, miscellaneous supplies, etc.)
Requires admininstrators' approval
Requisition Form For staff use only
Payroll Payment Voucher Use to request payment for stipends, chaperoning etc.
Authorization for Direct Deposit form Use this form to enroll in direct deposit
W-4  Form

To change your federal withholding amounts.

Omni 403b/457b Omni Link for Information & Forms
Classroom Coverage Request for Payment Use this form to request payment for classroom coverage
Tutor Time Sheet Use this form when you tutor a student.
Tutor Letter

This letter must be completed for non-lesson planning tutoring.

Tutor Letter

This letter must be completed for lesson-planning tutoring.

DUFSD Action Plan Template

Administrative Use Only.

Hourly Time Sheet

For hourly employees only.

Substitute Time Sheet Substitutes only.
Year -End Extra Curricular Attendance Form This form must be completed and submitted with any extra-curricular stipend payroll payment vouchers.
ACA - Health Insurance Required Yearly Form This form must be completed yearly during open enrollment period for ACA requirements.
2018 Empire BC/BS Alt PPO Summary of Benefits & Coverage Plan information regarding the Empire BC/BS Alt PPO Health Insurance Plan
2018 Empire BC/BS EPO 20 Summary of Benefits & Coverage Plan information regarding the Empire BC/BS EPO 20 Health Insurance Plan
2018 Empire BC/BS Alt PPO Blue View Vision Summary of Benefits Plan information regarding the Empire BC/BS Alt PPO Blue View Vision Health Insurance Plan
2018 Empire BC/BS EPO 20 Blue View Vision Summary of Benefits Plan information regarding the Empire BC/BS EPO 20 Blue View Vision Health Insurance Plan
2018 Empire BCBS Certificate of Coverage - Alt PPO Detailed plan information regarding the Empire BCBS Alt PPO Health Insurance Plan
2018 Empire BCBS Certificate of Coverage - EPO 20 Detailed plan information regarding the Empire BCBS EPO 20 Health Insurance Plan
New York State Tax Withholding To change your state withholding amounts.
Employee Accident Form Use this form if an employee has an accident on the job.


Dover Union Free School District   2368 Rt 22   Dover Plains, NY 12522   Phone: (845) 877-5700   Fax: (845) 877-5766

The Dover Union Free School District does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities.  
The following people have been designated to handle inquiries regarding the non-discrimination policies:

Donna Basting, Assistant Superintendent for Curriculum, Staff Development, and Technology
2368 Route 22, Dover Plains, NY  12522
845-877-5700 x1233 

Genie Angelis, High School Principal
2368 Route 22, Dover Plains, NY  12522
845-877-5700 x1143

For further information on notice of non-discrimination, visit http://wdcrobcolp01.ed.gov/CFAPPS/OCR/contactus.cfm for the address and phone number of the office that serves your area, or call 1-800-421-3481.

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