Forms

Forms

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Payroll & Human Resource Forms
Direct Deposit Authorization Form	This is the form that all employees must fill out to determine where their net pay will be direct deposited.
Employment Application - Teaching	Teaching Application for Employment (includes W-4, I-9, TB/MMR Shots, and 403(b) forms)
Employment Application - Non Teaching	Non Teaching Application for Employment (includes W-4, I-9, TB/MMR Shots, and 403(b) forms)
W-4 Form (Federal Tax Withholdings)	This is the W-4 form that is required by law to be filled out by all employee's to record federal tax withholding information. If you would like to change your federal tax withholding amount, print the form, fill it out and forward it to the Business Office.
W-4 Tax Withholding Calculator Instructions	Instructions for using the Tax Withholding Calculator program listed below.
W-4 Tax Withholding Calculator	To help employees ensure they do not have too much or too little income tax withheld from their pay. Most will find this more accurate and easier to use than the worksheets that accompany Form W-4. You may use the results of this program to help you complete a new Form W-4.
I-9 Employment Eligibility Verification	This form is required by law to be filled out by each employee before starting work, the form requires certain documents be presented before the form can be accepted.
Tuberculosis & MMR Immunization	Memo explaining the R.I. State law regarding these immunizations and where to obtain them
Post-Retirement Employment	Memo explaining the laws and reporting requirements for retired employees collecting a pension from ERS or MERS while working for the School Department.
ERS Post Retirement Employment Form	The form required by the Employees Retirement System to be completed by retirees on a monthly basis for all hours worked while collecting their pension.
ERSRI January 2003 Compass Newsletter	Newsletter from ERSRI that explains the restrictions for Post Retirement Employment
COBRA Initial Notice Form	This form explains your rights and responsibilities for health insurance under the COBRA laws.
Notice of Right to Elect COBRA Continuation Coverage (Termination or Reduction in Hours)	This form is given to the employee and spouse, when the employee is terminated or if there is a reduction in hours. The form must be completed by both people and returned to the employer. The form explains both person rights under COBRA.
COBRA Continuation Coverage Election Form (Termination or Reduction in Hours)	This form must be filled out by the employee and spouse when the employee is terminated or if there is a reduction in hours. Each person must notify the employer as to whether they wish to elect COBRA coverage.
Notice of Right to Elect COBRA Continuation Coverage (Death, Divorce, Legal Separation,Medicare Entitlement Loss of Dependent Status)	This form is given to the employee and spouse, whenever there has been a Death, Divorce, Legal Separation,
COBRA Continuation Coverage Election Form (Death, Divorce, Legal Separation, Medicare Entitlement, Loss of Dependent Status)	This form must be filled out by the employee and spouse when the employee or spouse is subject to one of the following (Death, Divorce, Legal, Separation, Medicare Entitlement, Loss of Dependent Status. Each person must notify the employer as to whether they wish to elect COBRA coverage.
Waiver of Health & Dental Insurance Form	Form that must be completed if you elect to waive any of your Health or Dental Insurance benefits.
Employee Counts by Year	Employee Counts by Year by Bargaining Unit Type

403(b) Annuity Forms & Information
403(b) Salary Reduction Eligibility Notification	Form required to be signed by every employee notifying them of our 403(b) Annuity Salary Reduction Program
403(b) Annuity Summary Plan	Explains what a 403(b) Plan is and its benefits
403(b) Annuity Guidelines and Policies	Explains the forms that must be filled out, the dates the forms are due, Catch-Up Provision, etc.
403(b) Annuity Approved Service Providers	This is a list of the approved insurance companies and service providers the school department allows.
403(b) Salary Reduction Agreement	The required form that must be filled out to initiate a 403(b) Annuity pre-tax payroll deduction. Your Service Provider must also complete Section 6, the Maximum Allowable Contribution (MAC) calculation as explained in Section 5 of this form.
403(b) Instructions for MAC Calculation	Provides the instructions for performing the Maximum Allowable Contribution calculation. (our employee's are required to perform the calculation if they select Fidelity as a Service Provider)
403(b) IRS Publication 571	This IRS Publication explains all the laws, rules, and regulations regarding 403(b) annuities.

Purchasing & Accounts Payable
Purchase Requisition Forms: Admin Baldwin Cunningham Varieur Curtis Winters Curvin Goff Fallon Jenks Greene Slater Little Tolman Potter Shea	Click on your school to print out the purchase requisition form for your school.
Requisitions - Regular - How to enter them	Detailed instructions on how to enter Regular requisitions on in the General Accounting Software
Requisitions - Allocation - How to enter them	Detailed instructions on how to enter Requisitions on in the General Accounting Software that must be cost allocated to several schools.
Requisitions - Helpful Data Entry Tips	Helpful Data Entry Tips for entering Requisitions into the General Accounting Software
Purchase Requisition Procedure	Instructions and requirements for filling out purchase requisitions and submitting to the Business Office.
Vendor Invoice Procedure	Instructions and requirements for submitting vendor invoices to the Business Office.
Budget Transfer Form	Use this form to transfer budget dollars from one account to another, to resolve possible over budget situations.
Budget Transfer Form - Large	Use this form to transfer budget dollars from one account to multiple accounts, or from multiple accounts to one account to resolve possible over budget situations.
Independent Contractor Agreement	Agreement that must be completed for all Independent Contractors that are not current employees and are not acting as an employee per IRS regulations that are stipulated in the agreement. Form W-9 below must also be submitted.
Form DWC-11-IC Designation of Status as an Independent Contractor	Link to R.I. Department of Labor and Training Workers Compensation Unit forms web page. The purpose of this DWC-11-IC form is to clarify the relationship between a contractor and the business hiring the contractor. Submitting this form means that the contractor is not an employee of the hiring business for workers' compensation purposes. The contractor is responsible for his own workers' compensation insurance coverage. The hiring business is not responsible to provide workers' compensation coverage for the independent contractor.
W-9 Request for Taxpayer Identification Number	Form must be completed per IRS regulations for all Independent Contractors and Vendors that are not current employees. Form must be submitted with the Independent Contractors Agreement above.
Textbook Order Forms: Baldwin Varieur Cunningham Webster St Curtis Winters Curvin Goff Fallon Jenks Greene Slater Little Tolman Potter Shea	Click on your school to print out the Textbook Order form for your school.

Class Size & Class Coverage

Class Size-Elementary

Class Size-Elementary Itinerant

Class Size-Secondary

Form that is required to be completed for Class Size overage reimbursement.

Class Coverage-Elementary

Class Coverage-Secondary

Form that is required to be completed for Class Coverage reimbursement.

Professional Development Funds
Request for Professional Development Funds	The form required to access Professional Development Funds
Professional Development Time Sheet	The required time sheet to pay school department employees for Professional Development hours

School Improvement Funds
Request for School Improvement Funds	The form required to access School Improvement Funds
School Improvement Fund Time Sheet	The required time sheet to pay school department employees for School Improvement Funds hours

Audit Documents
FY05 City of Pawtucket Audit	City of Pawtucket FY05 Audit Report & Financial Statements (includes School Department)
FY04 City of Pawtucket Audit	City of Pawtucket FY04 Audit Report & Financial Statements (includes School Department)
FY03 City of Pawtucket Audit	City of Pawtucket FY03 Audit Report & Financial Statements (includes School Department)
FY02 City of Pawtucket Audit	City of Pawtucket FY02 Audit Report & Financial Statements (includes School Department)

Miscellaneous Forms
Application for Use of Buildings	Application form to use or rent a school facility, building, gymnasium, auditorium, or classromm.
Bus Requisition Application	Application form to request use of a school bus.
Field Trip Request Form	To request permission for a student field trip
Grant Budget & Expenditure Guidelines	Guidelines that must be followed in order to set up a grant budget and make expenditures from it.
Grant Year End Cut Off Procedures	This explains the cutoff periods for all purchase requisitions and vendor invoices for all grants.
Local Budget & Expenditure Guidelines	Guidelines that must be followed in order to modify your Local budget and make expenditures from it.
Local Budget Year End Cut Off Procedures	This explains the cutoff periods for all purchase requisitions and vendor invoices for the local budget.
Material Stipend Request Form	Material Stipend Request Form
Material Stipend Policy	Material Stipend Policy and Procedures
Mileage Reimbursement Policy	Mileage Reimbursement Policy
Mileage Reimbursement Request Form	Mileage Reimbursement Request Form
Mileage Chart	Mileage Chart listing mileage between each school
Organizational Chart	This will print an organizational chart of the Pawtucket School Department, from the Superintendent down.
Out Of Building Request Form (replaces the Substitute Request Form)	Out of Building Request Form to request permission to attend conferences, workshops, meetings, etc.
Pupil Counts by Category by Year	Pupil Counts by year by category (reg. ed., spec. ed., bilingual, voc. ed.)
School Activity Account Guidelines	Guidelines for use of School Activity Funds
Telephone Directory	Telephone Directory of all phone extensions in School Department
Travel Expenditure Report	Form that must be used to be reimbursed for all Travel Expenditures
Tuition Reimbursement Form NT	Tuition Reimbursement Form for Non Teaching Employees
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