Forms and Documents

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    • All
    • Acceptable Use Policy AUP
    • Agreement to Withdraw from Special Education
    • Alternate Transportation for Joint Custody
    • Annual Log for Extra Classroom Activities
    • Application for Employment Certificate (AT-17) Working Papers (Student General Employment)
    • Application for Employment Permit (AT-22) Working Papers (Newspaper Carrier)
    • Authorization for Release of Information
    • BCBS Dental PPO
    • BCBS Find a Doctor
    • Calculation for Estimated Routine Mileage for Requisition Preparation
    • CEP and P2 Household Information Form
    • Change of Address (Student Household) Form
    • Children's Health Insurance Program
    • Claim Form
    • Code of Conduct
    • Codigo de conducta
    • Community Eligibility Provision Household Income Form
    • Consent Form for Authorization to Release Information
    • Consent Form for Medicaid Insurance
    • Continuing Teacher and Leader Education (CTLE) Certificate
    • Daycare/Babysitter Form (Alternate Busing)
    • Daycare/Babysitter Form (Alternate Busing) Spanish
    • Delta Dental BrushSmart
    • Delta Dental ID Card
    • Delta Dental NYSUT Member Benefits Trust
    • Delta Dental PPO
    • Delta Dental Provider Directory
    • Delta Dental Toothpic
    • Delta Dental Virtual Consult
    • Delta Dental Web and Mobile Resources
    • Delta DentalOrthodontic Benefits
    • Dental Health Form
    • Diploma Requirements NYS
    • Direct Deposit Form
    • District Comprehensive Improvement Plan
    • District Health History Form
    • District Wide Safety Plan
    • Elementary No Sub Coverage
    • Emergency Health Form
    • Employee Handbook
    • ESSA 2020-2021 Participation Rate Improvement Plan Emmet Belknap Intermediate School
    • Financial Statement Audit: Extra Classroom Activity Financial Statements
    • Financial Statement Audit: Final Financial Statements
    • Financial Statement Audit: Management Letter
    • Financial Statement Audit: Required Communications Letter
    • Fitness Center Informed Consent and Assumption of Risk Agreement
    • FOIL Form
    • FORM A Professional Development Approved Activities
    • FORM B Prior Approval Form for Continuing Teacher and Leader Education (CTLE) Requirement
    • FORM C Professional Development Tracking Log
    • FSA Dependent Care Claim Form
    • FSA Direct Deposit Claim Form
    • FSA HRA Claim Form
    • FSA HRA Eligible Ineligible Fact Sheet
    • FSA HRA Letter of Medical Necessity
    • FSA HRA Mobile Phone App
    • FSA HRA Portal Guide
    • Glossary of Health Terms
    • Google app consent form Acceptable Use Policy
    • Google Consent Spanish
    • Graduation Pathways (Spanish)
    • Graduation Requirements
    • Graduation Requirements Tracking Tool
    • Guidelines for Posting & Commenting on the LCSD Website & Social Media
    • Health Appraisal Form
    • Health Appraisal Form for Potential CSE Students
    • Health History Form
    • Health Insurance Marketplace Coverage Options
    • HLQ Spanish
    • Home Language Questionnaire
    • HRA Direct Deposit Form
    • In Service Credit Verification Form
    • Instructional Technology Plan (2022-2025)
    • Interpreter Translator Request Form
    • IT 2104 NYS Withholding Form
    • Medicaid FAQs
    • Medicaid FAQs (Spanish)
    • Medicaid Form
    • Medicaid Form (Spanish)
    • Medical Homebound Instruction Application
    • Medication Authorization Form: Field Trip
    • Medication Authorization Form: School Sponsored Event
    • Meeting Conference Procedures and Regulations
    • Migrant Education Program
    • Migrant Form Spanish
    • Mileage Allowance Request
    • Mileage Chart for Outside District
    • Mileage Chart in District
    • Name or Information Change Form
    • New Vendor Request Form
    • Nonpublic School Placement Consent
    • Non-Public Transportation Service Request
    • NYS Graduation Requirements Additional Options
    • NYS Graduation Requirements Additional Options Spanish
    • NYS Graduation Requirements Understanding Current New York Diploma Requirements
    • NYS Graduation Requirements Understanding New York Diploma Requirements Spanish
    • NYS Graduation Requirements: Understanding Exemptions due to COVID-19 Public Health Emergency
    • NYS Graduation Requirements: Understanding Exemptions due to COVID-19 Public Health Emergency Spanish
    • NYS Health Appraisal Form (Special Education)
    • Opioid Overdose Reporting Form
    • Organizational Chart
    • Parent Referral to Special Education
    • Parent Request for Medical Treatment at School
    • Parents Bill of Rights for Data Privacy and Security
    • Payroll Schedule 2022-23
    • Payroll Schedule 2023-2024
    • Physical Fitness Certification (AT-16) Working Papers
    • POS $200 $5.$10 copay $3 Rx
    • POS 200 $0.15 copay $3 Rx
    • POS 200 $0.15 copay $5.$10.$25 Rx
    • POS 200 $5.$10 copay $5.$10.$25 Rx
    • POS 200 Original $5.$10 copay $3 Rx
    • POS 200 Original $5.$10 copay $5.$10.$25 Rx
    • PPO 7200 High Deductible
    • Pre-Participation Physical Evaluation
    • Professional Development Plan
    • Proof of Residency
    • Registration for Students with Disabilities
    • Request for Prior Approval for Graduate Courses
    • Request to Share Student Information
    • Required NYS School Health Examination Form
    • Residency Questionnaire
    • School Boundaries
    • Secondary No Sub Coverage
    • Shared Decision Making Plan
    • Smart Schools Investment Plan
    • Social Media Guidelines
    • Special Transportation Form
    • Special Transportation Form for Medical or Physical Limitation
    • Strategic Plan
    • Student Ethnicity Document
    • Student Registration Checklist
    • Student Registration Documents Spanish
    • Substitute Employee Handbook
    • Substitute Extra Duty Payroll Form
    • Technology and Publicity Consent Form with Student Acceptable Use Policy AUP
    • Trad Blue 901 Rx $5.$10.$20
    • Traditional Blue GAP Claim Form
    • Transportation Concern Form
    • Transportation Request
    • W-4 Federal Withholding Form
    • W-9 Request for Taxpayer Identification Number and Certification
    • Workers Compensation C-2F Employer's First Report of Work-Related Injury/Illness
    • Workers Compensation C-3 Employee Claim
    • Workers Compensation C-3.3 Limited Release of Health Information
    • Workers Compensation Dear Injured Worker
    • Workers Compensation DT-1 Notice for Diagnostic Tests & Examinations
    • Workers Compensation Equian RX First Fill Information Sheet
    • Workers Compensation First Aid Report
    • Workers Compensation Forms Procedures
    • Workers Compensation HIPAA Authorization
    • Workers Compensation Injury & Illness Incident Report
    • Workers Compensation Instructions for Completing Employee Claim (Form C-3)
    • Workers Compensation Instructions for Completing Form C-2F Employer's First Report of Work-Related Injury/Illness
    • Workers Compensation Receipt for Employee Information Packet
    • Workers Compensation Statement of Rights
    • Your Paystub
    • All
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    • Health and Dental
    • Health Services
    • Health Services Student Services
    • Health Services Working Papers
    • Personnel Office
    • Personnel Office Working Papers
    • Professional Development
    • Special Education
    • Student Registration (English)
    • Student Registration (Spanish)
    • Student Services
    • Technology Data Security and Communications
    • Technology Data Security and Communications Social Media
    • Transportation
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