Online Forms

Index of Forms

Choose a topic to be taken to forms related to that department or subject:

• Attendance/Home Bound Schooling/ 
• HomelessDiscrimination/HarrassmentEmployee 
• Benefits/InsuranceFacility Use
• Field Trip Permission Slip
• Finance/Payroll/Personal LeaveFree and 
• Reduced Meal Applications and 
• PaymentsFundraisingHealth Form/Medical 
• Release/Student InsurancePersonnel/Jobs
• Purchasing/P-Cards/Declining Balance 
• CardsSafety/MaintenanceSchool EnrollmentSpecial Dietary 
• NeedsStaff 
• DevelopmentTechnology/ComputersTransportationTravelVolunteer 
• FormsWorker's Compensation

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Links to Forms

Attendance

• Application for Out-of-School Attendance Area (PDF) - Revised January 2015
• Application for Educational Leave for a Student (DOCX)- return to school principal
• Application/Referral Form for Homebound Services (PDF)
• Chronic Health Condition Statement (PDF)
• Homeless Notification Form (PDF) - to report students who may be homeless
• Request for Individual Exception to Attendance Requirement (PDF)
• Student Residency Form (PDF) - required for enrollment for all students (may type and print)

For proof of attendance for driver's licenses - call Hampshire High School (HHS) at 304-822-5016, either Megan Fuller, ext. 1011 or DiAnna Liller, ext. 1000.

Discrimination/Harassment

• Employee Report of Harassment Form (PDF)
  
• Student Report of Harassment Form (PDF)

Employee Benefits/Insurance

• AAA Membership Form (PDF)
• PEIA Online Forms and Downloads (goes to Public Employees Insurance Agency website)
• American Fidelity Assurance Forms
  • CompBenefits Forms:
    • Human Enrollment Form (PDF) Updated
    • Change Form - Vision or Dental (PDF)
    • Dental Claim Form (PDF)
    • Humana Vision Claim Form - Out of Network (PDF)

Facility Use

• Request for Use of Facility (HHS) (DOCX) - requires signatures of Principal and Athletic Director
  
• Use of School Facility Request Form (PDF)

Approved County Permission Slip/Form for Parents to Sign

• Field Trip Permission Form (PDF)

Finance/Payroll/Personal Leave

• Time Sheets
  • Homebound Instruction Record and Timesheet (PDF)
  • Homebound Instruction Record and Timesheet (PDF)
  • Overtime Authorization (PDF)
  • Long Term Substitute Report (XLS)
  • Request to Use an In-Lieu Day (DOC)
  • Request to Work an In-Lieu Day (DOC)
  • Teacher/Pupil Ratio (1st to 6th) (DOC)
  • Teacher/Pupil Ratio (Kindergarten) (PDF)
  • Time Sheet - Bus Driver (XLS)
    
  • Time Sheet - Hourly (PDF) - revised December 2013
  • Time Sheet - More than 200-Day Contract (PDF)
  • Time Sheet - Service Personnel (PDF)
• 20/24 Payroll Selection Form (PDF)- Select to get paid over 20 or 24 pays
• Personal Business Day Request
  • Request to use Personal Business Days(s) (DOC)
  • Request to use Personal Business Day(s) (PDF) 
• Personal Leave
  • Donated Leave Form - Application to be a Recipient (DOC)
    
  • Personal Leave Bank Membership Form (PDF)
  • Personal Leave Bank Withdrawal Form (PDF)
  • Vacation Request (DOC)
• Tax Withholding
  • W4 Form (PDF) - Federal (2020)
  • W4 MD State Form (PDF)
  • W4 Virginia State Form (PDF)
  • W4 West Virginia State Form (PDF)
• Banking - Direct Deposit (PDF)

Free and Reduced Meal Applications and Payments

• Applications
• Payments 

Fundraising

• Auto-donor form (DOCX) for the public to donate to TAA
• Auto-donor form (DOCX) for Hampshire County Board of Education Employees to donate to TAA
• Cash Receipts Summary (PDF)
• Cash Receipts Summary (XLS) (Excel version to complete on computer)
• Fundraiser Application Form (PDF) (Revised July 2013 to replace all old forms)
• Fundraiser Profit/Loss Report Form (PDF)

Health/Medical/Student Insurance

• Emergency Procedure Card (PDF) - to be completed and sent to school to update information
• Medical Information Release Form (FERPA) (PDF) (may be typed, then printed and signed
• Medication Authorization Form (PDF)
• Student Accident Insurance Enrollment Forms, Instructions and Claim Forms - available from QBE Insurance Company

Personnel/Jobs

• All - Drug Free Workplace Verification Statement (PDF) (required of all employees)
• Coaching - Authorized Certified Coaches Guidelines (PDF)
• SearchSoft Online Job Application (on Teach West Virginia website)
• SearchSoft Employee Online Job Transfer Application (on Teach West Virginia website)
• Volunteer Form (PDF)- requires signature of principal at school where volunteering

Purchasing/P-Cards/Declining Balance Cards/Fundraising

• Declining Balance Card Application (PDF) (for Faculty Senate funds)
• Declining Balance Card Log (PDF) Revised July 2015 
• Declining Balance Card Procedures (PDF)
• P (Purchasing)-Card Procedures (PDF)
• P(Purchasing)-Card Log (PDF)Revised  April 2016  

Safety/Maintenance

• Custodial Supply Order Form (PDF) - updated for 2014 to 2015
• Fire Drill Exit Safety Report Form (PDF)
• School Dude Access (PDF)
• School Fire Exit Drill Safety Report (PDF) - must be posted at all schools
•  Unusual Incident/Accident Report Form - Student (XLSX) Revised
• Unusual Incident/Accident Report Form - Employee (PDF) Revised

School Enrollment

• Parent Enrollment Checklist (PDF)

Special Dietary Needs

• Parent Letter of Information about Special Dietary Needs for Students
  • Release of Information Statement (for back of Parent Letter) (PDF)
• Physician Letter of Information about Special Dietary Needs for Students (PDF)
  • Definitions of Children with Disabilities and Special Dietary Needs (for back of Medical Statement (PDF)
  • Medical Statement by Physician (to be attached to Physician Letter (PDF))

Staff Development

• Staff Development Proposal Plan (PDF)

Technology/Computers

For teachers:

• Acceptable Use and Email Forms (PDF)
• End of Year Technology Checklist (PDF)
• Equipment Sign Out Form (PDF)
• Password Keeper Form (PDF)
• RESA8 Equipment Repair Request Form
• Technology Inventory Forms

Transportation/Field Trips

• Passenger Manifest (PDF)
• Passenger Manifest (RTF) must be given to driver
• Transfinder LE - for home connection
• Transfinder LE - for school connection
  
• Trip Request (PDF) - for initial use only if required by school - Do not send to the Board/Transportation as all trips must be entered in Transfinder by school for approval!
• New Bus Enrollment Form (PDF) - to enroll new students in the transportation system
• New In Lieu Monthly Documentation Form (PDF) (2016 to 2017 ) - monthly in lieu reimbursement form
• New In Lieu Application Form (PDF) (2016 to 2017) - request to transport student(s) in a personal vehicle
• 
  

Travel

• Travel Request Form for In or Out-of-County Travel (PDF) - (print and complete by hand) - must have an approved trip request to receive reimbursement.
  
• Travel Request Form for In or Out-of-County Travel (XLX) - (type and then print) - must have an approved trip request to receive reimbursement.

Reimbursement Forms

• In-County Expense Form (XLSX) for travel after January 1, 2020
• New Mileage Chart (XLSX)- at 0.57.5 per mile for travel after January 1, 2020
• Old Mileage Chart  (XLSX) - at 0.58 per mile for travel before January 1, 2020 before January
• Out-of-County Expense Form (XLSX) for travel after January 1, 2020 
• In-County Expense Form (XLSX) for travel before January 1, 2020 
• Out-of-County Expense Form (XLSX) for travel before January 1, 2020 

Volunteer Agreement Form  

• Updated Volunteer Form (DOC)- updated 2020 to 2021 - Please use this new form

Also complete the following: 

• New Tuberculosis Statement (PDF) - required for all new employees and volunteers starting 2015 to 2016

Worker's Compensation

• Hampshire County Unusual Incident Report (PDF) New July 2017
• Election of Option Form for Workers Compensation (DOC)
• Updated West Virginia Worker's Compensation Employee's and Physician's Report of Injury (PDF) (for Brickstreet)