Embedded Files
Required Notices
Required Notices
Employer Sponsored Meeting Notice
Nursing Mother Employee Notice
Leave of Absence
Leave of Absence
Family and Medical Leave Act (FMLA)
Payroll Forms
Payroll Forms
Federal Tax Withholding - Federal Form W4 (Must also submit new MN W4 even if no changes are being made.)
State Withholding - State Form W4 (Must also submit new Federal W4 even if no changes are being made.)
Health Savings Account - Payroll Deduction Authorization
403(b) Salary Reduction Agreement
Insurance Forms / Information
Insurance Forms / Information
Insurance forms are not available on the website because additional information is needed to determine action to be taken.
Coverage Summaries:
Coverage Summaries:
$15 Copay (Summary of Coverage)
$20 Copay (Summary of Coverage)
$1650 Deductible (Summary of Coverage)
$4000 Deductible (Summary of Coverage)
Cost Calculators:
Cost Calculators:
Insurance Cost Calculator - Teachers
Insurance Cost Calculator - Local 284 Multi Unit
Insurance Cost Calculator - Transportation
Insurance Cost Calculator - Community Ed.
Health Savings Accounts/Flexible Spending Accounts:
Health Savings Accounts/Flexible Spending Accounts:
Health Savings Account - Payroll Deduction Form
HSA Account Set-Up (Magnifi)
403(b):
403(b):
403(b) Salary Reduction Agreement
Group Life Term
Group Life Term
Certificate of Insurance - Teachers
Certificate of Insurance - Support Staff
Certificate of Insurance - Transportation
Insurance - Life Beneficiary Change
Long Term Disability
Long Term Disability
Certificate of Insurance - Teachers
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