Hampshire County Schools - Official Website

Links to Forms - See Index above for quick links to each department or topic!

Attendance

*Student Residency Form - *required for enrollment for all students (may type & print)
Chronic Health Condition Statement
Request for Individual Exception to Attendance Requirement
Application for Out-of-School Attendance Area - Rev. 1/15
Application for Educational Leave for a Student - return to school principal

Application/Referral Form for Homebound Services
Homeless Notification Form - to report students who may be homeless
For proof of attendance for driver's licenses - contact the Superintendent's Office at 304-822--3528; ext 120

Discrimination/Harrassment

Employee Benefits/Insurance

PEIA Online Forms & Downloads (goes to Public Employees Insurance Agency web site)
American Fidelity Assurance Forms
AAA Membership Form

CompBenefits Forms:

Facility Use

NEW Use of School Facility Request Form Rev. 9/8/15

Finance/Payroll/Personal Leave

Time Sheets
- Time Sheet - Hourly - rev. 12/13
- Time Sheet - Service Personnel
- Time Sheet - More than 200-Day Contract
- Time Sheet - Bus Driver
- Overtime Authorization
- Long Term Substitute Report
- Teacher/Pupil Ratio (1st - 6th)
- Teacher/Pupil Ratio (Kindergarten)
- Homebound Instruction Record & Timesheet (PDF version)
- Homebound Instruction Record & Timesheet (Word 2007 version)
- Request to Work an In-Lieu Day (Word 2007 version)
- Request to Use an In-Lieu Day (Word 2007 version)
20/24 Payroll Selection Form - Select to get paid over 20 or 24 pays

Personal Business Day Request
- Request to use Personal Business Days(s) - Word version
- Request to use Personal Business Day(s) - PDF version
Personal Leave
Tax Withholding
- W4 Form - Federal
- W4 WV State Form
- W4 MD State Form
- W4 VA State Form
Banking - Direct Deposit

Free & Reduced Meal Applications & Payments

Applications @ http://wvschoolmeals.net
Payments @ https://wv.parentonline.net/

Fundraising

Fundraiser Application Form (rev. 7/13 to replace all old forms)
Cash Receipts Summary (pdf version to print)
Cash Receipts Summary (Excel version to complete on computer)
Fundraiser Profit/Loss Report Form
Auto-donor form for the public to donate to TAA
Auto-donor form for Hampshire County Board of Education Employees to donate to TAA

Health/Medical/Student Insurance

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

Personnel/Jobs

SearchSoft Online Job Application (on Teach West Virginia web site)
SearchSoft Employee Online Job Transfer Application (on Teach West Virginia web site)
All - Drug Free Workplace Verification Statement (required of all employees)

Volunteer Form- requires signature of principal at school where volunteering
Coaching - Authorized Certified Coaches Guidelines

Purchasing/P-Cards/Declining Balance Cards/Fundraising

Declining Balance Card Application (for Faculty Senate funds)
Declining Balance Card Procedures
Declining Balance Card Log rev. 7/2015 (Excel)

P (Purchasing)-Card Procedures
P(Purchasing)-Card Log rev. 4/2016 (Excel)

Safety/Maintenance

School Fire Exit Drill Safety Report - must be posted at all schools
School Dude Access
Custodial Supply Order Form - updated for 2014-15
Fire Drill Exit Safety Report Form
Unusual Incident/Accident Report Form - Student Revised (Word version)
Unusual Incident/Accident Report Form - Student Revised (PDF version)
Unusual Incident/Accident Report Form - Employee (Word version)
Unusual Incident/Accident Report Form - Employee (PDF version)

Special Dietary Needs

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

Staff Development

Staff Development Proposal Plan

Technology/Computers

FOR TEACHERS:

Transportation/Field Trips

Trip Request - 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!
Transfinder LE - for home connection
Transfinder LE - for school connection
Passenger Manifest (Word) - must be given to driver
Passenger Manifest (PDF)

NEW Bus Enrollment Form - to enroll new students in the transportation system(fillable on computer)
NEW In Lieu Application Form (2016-17) - request to transport student(s) in a personal vehicle (fillable on computer)
NEW In Lieu Monthly Documentation Form (2016-17) - monthly in lieu reimbursement form (fillable on computer)

Travel

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

NEW Mileage Chart - $0.53.5 per mile for travel after Jan. 1, 2017

In-County Expense Form for travel after Jan. 1, 2017 (Excel to do on computer)

In-County Expense Form for travel after Jan. 1, 2017 (PDF to print & do by hand)

Out-of-County Expense Form for travel after Jan. 1, 2017 (Excel to do on computer)
Out-of-County Expense Form for travel after Jan. 1, 2017 (PDF to do by hand)

OLD Mileage Chart - $0.54 per mile for travel before Jan. 1, 2016
In-County Expense Form for travel before Jan. 1, 2016

Out-of-County Expense Form for travel before Jan. 1, 2016

Volunteer Agreement Form

UPDATED Volunteer Form - updated May 2017 - Please use this new
Also complete the following:
NEW TB Statement - required for all new employees and volunteers starting 2015-16

Worker's Compensation

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

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