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Opening 2021-22 Information

Forms

Health & Dental

Excellus Enrollment Form

Excellus Medical Claim Form

Excellus HIPPA Authorization Form

Excellus International Claim Form

Delta Dental Enrollment Form

Personal Information

Employee Information Change Form

Directions to change your name through NYS Dept of Education

Incident Reporting Forms

Allegation of Child Abuse

Workers Compensation

Employee Report of Workplace Injury

Retirement Forms

TRS - Retirement Application

TRS - Loan Application

TRS - Change Beneficiary

TRS - Name & Address Change

ERS - Retirement Application

ERS - Loan Application Tier 1 & 2

ERS - Loan Application Tier 3 - 6

ERS - Change of Beneficiary

ERS - Change of Address

ERS - Name Change

Tax Forms

W4 Federal Tax Form 2022

IT - 2104 State Tax Form 2022

Application Forms

Broome County - Support Staff Application

Bus Driver Application

Substitute Administrator Application

Substitute Teacher Application 2021

Substitute Support Staff Application 2021

Coaches & Mentors without Pay Application

School Volunteer Application

Flexible Spending

Flexible Benefits - Program Enrollment Form

Flexible Benefits - Request for Reimbursement Claim Form

Payroll Forms

Tax Shelter - OMNI

AA - Admins 10.5 Month Payroll Selection

ETA - Payroll Selection

CWA, SAA & Transportation - 10 Month Payroll Selection

OPA - 10 Month Payroll Selection

OPA - 10.5 Month Payroll Selection

Other Forms

Report/Request for Extracurricular Activity

Teacher Over Time Submission Form

Teacher Aide Over Time Submission Form

Over Time Submission Form - Standard

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