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This site is a depository for forms used by the Jefferson County Public School District. Most of the forms at this site are available in Portable Document Format (PDF) and feature fill-in-the-blank fields, which allow the forms to be completed on-line. Some forms feature special controls, such as drop-down lists, check boxes, or calculated fields to speed data entry. To use the forms, you must have Adobe Acrobat Reader, which is freely downloadable by clicking the Get Acrobat Reader icon below. With Adobe Acrobat Reader, you can open a form, complete the form on your computer, and print a copy of the form. However functions of the free Reader are limited to printing and saving the form.
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24-hour Accident Insurance Information and Application24StuAccInsurLetter.pdfComplete and mail with premium to: Bollinger, Inc P.O. Box 5000 Short Hills, NJ 07078
Acceptable Use Policy EmployeeAUPEmployee.pdfPlease complete this form
Acceptable Use Policy Studentcodeofconduct.pdfAUP is located on page 24 of the Student Code of Conduct
Addendum to JCPS District Purchase OrderAddJCPS_POform.pdf486-1Order this form online from the JCPS Warehouse using approved procedures.
Administrative Directory2012-13 Administrative DirectoryDigital version of 2012-13 Administrative Directory
Administrative Sick Leave Bank ApplicationSickAdminApp.DocReturn completed form to President JCASA, Liberty High School
Administrative Sick Leave Bank ProceduresSickAdminProcedures.PDFPrint out or download for your records
Administrator Performance Evaluation Notice of Significant Deficiencies (Form A)forma.docPrint out or download and complete
Administrator RecommendationAdministrator_Recommendation.pdfComplete this form, print and fax to 485-7013
Aegon Application 2007AegonApplication.pdfFollow instructions, complete form and send to Terry Crawley Archdiocese of Louisville Flaget Center 1935 Lewinston Drive Louisville, KY 40216
After School Enrichment-Edu Program ApplicationAppAfteSchEnrichEdProg.pdfPrint, fill out by school personnel and submit with Fac/Grnds Application
Air Filter LogAirFilterLog.pdfPrint out form, complete, and submit as needed.
American Fidelity Assurance Cancer BrochureAmerican Fidelity Assurance Cancer BrochurePrint out, complete form and submit to Cyndi Godsey, AFA, 3701 Fringe Tree Pl., Louisville, KY  40241
American Fidelity Assurance Short Term Disability BrochureAmerican Fidelity Assurance Short Term Disability BrochurePrint out brochure and application, complete application and return to Cyndi Godsey, AFA, 3701 Fringe Tree Pl., Louisville, KY  40241
AP Vendor Direct Deposit Authorization FormAcctsPayDirDepositAgree.pdfPrint for and complete
Application for Emergency LeaveApplicforEmergLeave.pdf447-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 5 1/2" x 4 1/4", blue cardstock, printed both sides. Order by Package of 50 forms. Commodity Code is 5690404-1681649.
Application for Home/Hospital Instruction (English) Home_Hospital_Application_Eng.pdfComplete and sign the first page of the application, have a medical professional complete the second page, and return either by mail to: Home/Hospital Program, Jefferson County Public Schools, PO Box 34020, Louisville, KY 40232-9987 or by fax to: 485-6317
Application for Home/Hospital Instruction (Spanish)Home_Hospital_Application_Spn.pdfComplete and sign the first page of the application, have a medical professional complete the second page, and return either by mail to: Home/Hospital Program, Jefferson County Public Schools, PO Box 34020, Louisville, KY 40232-9987 or by fax to: 485-6317
Application for Sick Leave CardApplication for Sick Leave Card430-1AThis form must be ordered from the Warehouse using MUNIS. Form is printed on 5 1/2" x 4 1/4" white cardstock. Order by Package of 50 forms. Commodity Code is 5690404-1681652.
Assistant Principal EvaluationAPEVAL.docPrint out and complete
Assistant Principal Notice of Significant Deficiencies Evaluation, Form AFORMATIVEEVALUATIONA.DOCPrint out or download and complete
Assistant Principal Performance Standardsapstandards.DOCPrint out or download
Athletic Accident Insurance ProgramAthleticAcc.pdfPrint out form, complete, and submit as directed.
Attendance AuditAttendanceAudit.pdfComplete, print out form, and submit as needed.
Attendance CreditAttendanceCREDIT.pdf
Attendance RecordAttendanceRecord.pdfPrint out form, complete, and submit as needed.
Attendance StipendAttendanceSTIPEND.pdfComplete this form, and follow instructions
Automobile Accident Claim FormAutoAccidentClaimForm.pdfPrint out form, complete, and submit as directed.
Bid LetterBid_Letter.pdfComplete this form and return to Human Resources.
Blood Test Consent FormBloodTestConsent.pdfPrint out form and complete.
Board Paid Insurance–Overnight Field TripsBrdPdIns04.pdfPrint out information
Board Recognition Recommendation FormBoardRecognitionRec.pdfRecommend students and staff for Board recognition
Bomb Threat Checklistbombthreat.pdfPrint out
Building Maintenance Work Order RequestBldgMaintWOReqst.pdfPrint out form and complete. (This form prints out two forms to an 8 1/2" x 11" sheet. Needs to be cut to 8 1/2" x 5" and will yield two forms.)
Building Modification FormBuildingModForm.pdfBM-1Request for Building Modification - Save the form, fill it out, and email to the address on the form.
Bus Incident ReportBus_Incident_Report.pdfComplete this form and return to Transportation.
Camp Insurance Request FormUnderwritersSafetyClaims.pdfComplete this form, and follow instructions
Car Rental Allowancecarrental.xlsThis form may be slow to load due to the calculation fields.
CERS Retirement Procedures BrochureCERSRetirement.pdfPrint out, complete and return to the Benefits office.
Certificate of CoverageCertificateofCoverage.pdfComplete this form, and follow instructions
Certified Classified ReportCERTIFIEDCLASSIFIEDREPORT.pdfComplete this form, and follow instructions
Certified Staff Recommendationstaffrecommendationcert.pdfComplete this form, and follow instructions
Chemical and Chemical Product Inventory ListChemInventory.pdfPrint out form, complete, and submit as directed.
Classified Hourly Evaluation Form (Form F)formf.docPrint out or download and complete
Classified Performance Evaluation Instructions (Revised 7-1-06)classifiedeval.docPrint out or download
Classified Substitute EvaluationCLSUBEV.pdfPrint out, complete and fax to Mary Persley 485-6454
Classroom Instructional FrameworkClassInstructFrame.docThis form can be used by middle school teachers as a general (not content-specific) guide in planning lessons. It can also be used as a recording tool during whole-or partial-period classroom observations. A key component of this observation process is to
Cluster 1 Application 2012-13Cluster1v4_Interactive.pdfPrint application on plain paper. Make copies as needed. The form is interactive and can be completed online.
Cluster 2 Application 2012-13Cluster2v4Interactive.pdfPrint application on plain paper. Make copies as needed. The form is interactive and can be completed online.
Cluster 3 Application 2012-13Cluster3v4Interactive.pdfPrint application on plain paper. Make copies as needed. The form is interactive and can be completed online.
Cluster 4 Application 2012-13Cluster4v4Interactive.pdfPrint application on plain paper. Make copies as needed. The form is interactive and can be completed online.
Cluster 5 Application 2012-13Cluster5v4Interactive.pdfPrint application on plain paper. Make copies as needed. The form is interactive and can be completed online.
Cluster 6 Application 2012-13Cluster6v4Interactive.pdfPrint application on plain paper. Make copies as needed. The form is interactive and can be completed online.
Collegial Support Committee Review Verification P5.DOCComplete this form, and follow instructions
Collegial Support Committee Review Verification Form (P-5)formp5verification.docPrint out or download and complete
Colonial Cancer Brochurecolcancer.pdfPrint out, complete and return to Creative Employee Benefits, 7410 New LaGrange Road, Suite 204, Louisville, KY 40222
Colonial Supplemental Health Brochure and Applicationsupplementalhealth.pdfPrint out brochure, complete application and return to Creative Employee Benefits, 7410 New LaGrange Road, Ste. 204, Louisville, KY 40222
Communication Form Acommforma.docPrint out or download and complete
Communication Form Bcommformb.docPrint out or download and complete
Communication Form Ccommformc.docComplete this form, and follow instructions
Communication Form Dcommformd.docComplete this form, and follow instructions
Communication Procedurecommproconly.docPrint out or download for your records
Computer Warranty RepairComputer Warranty Repair
Conference Form, Parent-Teacher-StudentConfForm.pdf432-2Print out from JCPS Online Forms website. Form is printed on 8 1/2" x 11" white paper.
Conference Summaryconf.DOCDownload or print out and complete
Confidential-Essential Classified Sick Leave Bank ApplicationSickConfEssentSEIUApp.docReturn completed form to Executive Director, Human Resources VanHoose 3rd Floor
Contract Procurement FormContractProcurement.docNC D&FUse this form when the item you are purchasing meets one of the criteria listed. Attach this form as documentation.
Copyright Permission Request Formcopyrightperm.pdfThis form is interactive. Fill out form, print completed form, and submit as directed on bottom of form. Or, download form, print form, and complete by hand.
Corrective Growth PlanningCORRECTIVEGROWTHPLANNING.docEvaluation to be completed by supervisor. Print out or download to computer, complete
Counselor Administrative Performance Evaluation, Form Bformb.docPrint out or download and complete
Counselor Criteria And Indicators Effective School Guidance Counselorscounselorstds.docComplete this form, and follow instructions
Counselor Performance Evaluation Instructionscounselorinstructions.DOCPrint out or download
Counselor Performance Evaluation Instructions and Forms Table of Contentscounselortoc.docComplete this form, and follow instructions
Counselor Performance Standardscounselorperfindicators.docPrint out or download
Counselor Referral FormCounselorReferralForm.pdf464-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 5 1/2", 2-part carbonless set. Order by Package of 50 forms. Commodity Code is 5690404-1681657.
Course Additions-Change Request FormCourseRequest.docPrint or download and complete. Send to the appropriate person as indicated on the form.
Credit applicationCreditapplication.pdfComplete this form, and follow instructions
Daily Medical LogDailyMedLog.pdfComplete as directed
Damage or Short ReportDamage_or_Short_Report.pdf438-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 5 1/2", 3-part form for use with carbon paper. Order by Package of 50 forms. Commodity Code is 5690404-1681658.
Deduction Scheduledeductionschedule.pdfPrint form and complete
Design ManualDesignManual.pdf
Direct Deposit Formdirectdeposit.pdfPrint form and complete
Discharge RecommendationDISCHARGEREC.DOCDownload or print out and complete
Disciplinary NoticeDisciplNotice.DOCPrint out or download and complete
Early Dismissal from SchoolEarly_Dismisal_form.pdf484-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 2 1/2" x 4 1/4", white paper with red ink Order by Pad of 50. Commodity Code is 5690404-1725636.
Early Learning SkillsJCPSEarlyLrng1up.pdf323-2Forms will be sent from Materials Production based on your enrollment plus 25%.
ECE Elementary School Progress Reporteceelemreptcdpg1.pdf315-3This form must be ordered from the Warehouse using MUNIS. Form is printed on 8.5" x 11" White Cardstock (printed on both sides). Order by each. Commodity Code is 5690404-1692154.
ECE Occupational Therapy Service LogECE_OT_serv_form.pdf
ECE Physical Therapy Service LogECEPhysThrpyFrm08.pdfPrint form and complete hard copy
Elementary Closing ChecklistElemClosingChecklist.pdfPrint and complete
Elementary Opening ChecklistElemOpenChecklist.pdfPrint and complete
Elementary School Interim Report CardElemInterimRptCd.pdf318-3Forms will be sent from Materials Production based on your enrollment plus 25%.
Elementary Student Assignment Temporary Enrollment FormTempEnrollForm.pdfForm is an interactive pdf. It can either be printed and completed by pen and ink, or it can be completed on the computer and then printed.
Elementary/Middle School Permanent RecordELEM_MIDPrmRcrd.pdfComplete this form, and follow instructions
Emergency Procedures (poster)EmergProcedFrm04.pdf461-1This form is an interactive pdf form. Complete the form online and print. This form is also available on the Safety and Environmental Web Site.
Employee Auto Insurance Affidavit FormautoInsAffidavitForm.pdfPrint out form, complete, and submit as directed.
Employee Emergency InformationEmploy_Emerg_Info.pdf473-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 5 1/2" green cardstock Order by Package of 50 forms. Commodity Code is 5690404-1681667.
Energy Management Extended Hour Schedule of ActivitiesEnergyManagementRequests.DocPrint out copy of form , complete requested information and then fax to 485-3606
Enrollment InformationEnrollmentForm.pdf489-1This form is to be printed from the JCPS Forms website. The form is interactive and may be completed on the computer and then printed. Form gets printed on 8.5" x 11" white paper. Commodity Code is 5690404-1731828.
Envelope for Elementary Progress Report and Report CardElemReportEnv.pdf315-4AForms will be sent from Materials Production based on your enrollment plus 25%.
Evaluation Instructions for pdCentralEvaluation.pdfComplete this form, and follow instructions
Event Insurance ApplicationEvent_Insurance.docPrint form, complete, submit with $50 insurance premium with Facility and grounds use application.
ExCEL Award Application FormExCELNomination.pdfSend form to Terri Robinson, JCPS ExCEL Award Coordinator, Communications North, C. B. Young, Jr., Service Center, Bldg. 4. Application deadline is Friday, February 21, 2014. Faxes not accepted.
Exposure Incident ReportExposureIncident.pdfPrint out form, complete, and keep on file as directed.
Extra Help Request FormExtraHelpReq.pdfThis is an interactive form. Complete the form on your computer and print copy.
Facility and Grounds Use ApplicationFacilityGrndsUseApp.pdfPrint out form, complete, and submit as directed.
Facility Use (Procedures and Guidelines)FaclilityUseReg.pdfPrint out form, complete, and submit as directed.
Facility Use Application ChecklistFacilityPermitChecklist.pdfPrint, fill out by school personnel and submit with Fac/Grnds Application
Federal tax Withholding Form W-4fw4.pdfPrint form and complete
Field Trip Approval FormFieldTripApproval.pdfFor all school sponsored or school endorsed trips, the supervising teacher must complete this form, obtain the principal’s approval and distribute the form as indicated.
Field Trip Entry Exit LogFTEntryExitLog.pdfComplete this form, and follow instructions
Field Trip Insurance Certificate (International)FieldTripInsurInter.pdfComplete this form, and follow instructions
Field Trip Permission FormFieldTripPermission.pdfFor all school sponsored or school endorsed trips, the supervising teacher must complete this form and obtain the signature of the parent/guardian of each student attending the trip.
Field Trip PoliciesFieldTripPolicies.pdfReview
Field Trip ProcedureFieldTripBklt.pdfFor all school sponsored or school endorsed trips, the supervising teacher/school must follow these procedures.
Fire Disaster Drill LogFireDisasterDrillLog.pdfPrint out form, complete, and keep on file as directed.
Florida Purchasing Exempt CertificateFLpurchExempCert.pdfComplete this form, and follow instructions
Flying vs MileageFlyingvsMileage.xls
FMLA - Employee’s Serious Health ConditionEmploySeriousHealthCond.pdfPlease complete the employee section of the form, print, take to your physician for completion and forward to the appropriate Human Resource Personnel.
FMLA - Medical LeaveFMLA_Medical_Form.pdfPlease complete the employee section of the form, print, take to either your or your family members physician for completion and forward to the appropriate Human Resource Personnel.
FMLA - Qualifying Exigency For Military Family LeaveQuailifyExigencyMilFamLeave.pdfPlease complete the form, print, and forward to the appropriate Human Resource Personnel. Written documentation to support the qualifying exigency must accompany the certification form (see section II of the form for details).
FMLA - Serious Injury or Illness of Covered Servicemember for Military Family LeaveSerInjuryCovServMilFamLeave.pdfPlease complete the employee and/or covered servicemember section, print, take to the covered service member’s healthcare provider for completion and forward to the appropriate Human Resource Personnel.
FMLA Family PosterFMLAFamilyPoster.pdfComplete this form, and follow instructions
FMLA Millitary PosterFMLAMillitaryPoster.pdfComplete this form, and follow instructions
Formative Evaluation Form E-1, Notice of Significant Deficienciese1.docPrint out or download and complete
Formative Evaluation Form E-2 Administrator (E2)E2Admin.docFill in, Print out or download and complete
Formative Evaluation Form E-2 Assistant Principal (E2)E2AssistantPrincipal.docFill in, Print out or download and complete
Formative Evaluation Form E-2 Counselor (E2)E2Counselor.docFill in, Print out or download and complete
Formative Evaluation Form E-2 Principal (E2)E2Principal.docFill in, Print out or download and complete
Formative Evaluation Form E-2 Teacher (E2)E2Teacher.docFill in, Print out or download and complete
Forms Catalog120105WHCatalog.pdf1Pdf file of current warehouse forms available and how to find and order.
Four-Year Plan, High School ProgramFourYrPlanHS.pdf105-2This form must be ordered from the Warehouse using MUNIS. Form is printed on an 11" x 8 1/2", 4-part carbonless set. Order by packages of 50 sets. Commodity Code is 5690404-1681676.
Function ChartFUCTIONCHART.PDFPrint out or download
Generic Payment VoucherGeneric Payment VoucherF-485-1aPrint from this site and make copies as necessary. See Payment Voucher Instructions (pg 2) for details on completing the form.
Grievance Form Agrievforma.docPrint out or download and complete
Grievance Form BGRIEVFORMB.DOCPrint out or download and complete
Growth Plan for Counselors (Form G)formgcounselor.docPrint out or download and complete
Growth Plan, Form Gformg.docPrint out or download and complete
Hazard-Safety Spot CheckHazSafetySpotCk.pdfF-423-1Print out form, complete, and submit as directed.
Hepatitis B Vaccine DeclinationHepBVacDeclin.pdfPrint out form, complete, and file as directed.
High School - Permanent RecordHighScholPrmRcrd435_1.pdf435-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 9" folder printed on all sides. Order by Package of 50 forms. Commodity Code is 5690404-1681719.
High School Feeder CardHighSchlFdrCard.pdf206-2This form must be ordered from the Warehouse using MUNIS. Form is printed on an 8 1/2" x 5 1/2" White cardstock. Order by packages of 50 cards. Commodity Code is 5690404-1681681.
High School Progress Report and Report Card*HS_ProgRpt_pg1.pdf121-3This form must be ordered online from Warehouse using MUNIS. The form is printed on 8.5" x 14" White Index and is packaged 10 forms to a package. Order by packages of 10 forms. Commodity Code is 5690404-1709917.
High School—Schedule CardHighSchlSchedCard.pdf101-2This form must be ordered from the Warehouse using MUNIS. Form is printed on a 4" x 6" white cardstock. Order by packages of 50 cards. Commodity Code is 5690404-1681682.
Hyatt Legal Brochurehyatt1.pdfPrint out brochure for your records
I Am JCPS Star Performer AwardIAmJCPSStarPerformer.pdfPlease use a separate form for each employee you are nominating. The nomination form must be filled out completely, printed and signed/approved by the nominee’s supervisor. Please return the completed form through the Pony to the Public Information Office
Indiana Tax Withholding Formwh-4.pdfPrint form and complete
Individual Graduation PlanIndividualGradPlan.pdf487-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 11" x 17 1/2", white 110# index. Order by Packages of 50. Commodity Code is 5690404-1728721.
InDoor Air Quality (IAQ) Complaint Response Request FormIAQRequestForm.pdfPrint out form, complete, and file as directed.
Instructions For Evaluation Of AdministratorsadminInstructions.docPrint and follow instructions
Instructions For Evaluation Of Assistant Principalsapinstructions.DOCPrint and follow instructions
Instructions for Teacher Performance Evaluation Significant Deficiencies NotedsignificantINSTRUCTIONS.DOCPrint out or download
Integrated Pest Management FormsIntegPestMgt.pdfPrint out form, complete, and file as directed.
Integrated Pest Management Pesticide Application NoticeIPMnotice.pdfPrint Form and complete. Follow instructions from Environmental Safety Department.
Interim Summative Principal Evaluationinterimsummative.DOCPrint or download and complete
Intermediate Report CardElemIntermedRptCrd.pdf315-2Forms will be sent from Materials Production based on you enrollment plus 25%.
JCAESP Sick Leave Bank ApplicationSickJCAESPApp.docReturn completed form to Sick Leave Bank JCAESP/AFSCME Local 4011, 4315 Preston Highway # 101 Louisville, KY 40213
JCAESP Sick Leave Bank ProceduresSickJCAESPProcedures.pdfPrint out or download for your records
JCBE-AFSCME AgreementAFSCME.pdfPrint out for your records
JCBE-JCSNA AgreementJCSNA.pdfPrint out for your records
JCBE-JCTA Contractjcta.pdfPrint out for your records
JCBE-SEIU AgreementSEIU.pdfPrint out for your records
JCBE-Teamsters Contractteamsters.pdfPrint out for your records
JCPS Leave Contact Informationjcpscontactinfo.pdfComplete this form, and follow instructions
JCPS Product Evaluation FormProductEvaluation.pdfPrint out form, complete, and submit as directed.
JCTA Extensionjcta_Extension.pdfComplete this form, and follow instructions
Kentucky Tax Withholding Form K-442a804.pdfPrint form and complete
Kid Trax Release 1KidTraxRelease-1.pdfComplete this form, and follow instructions
KidTrax Confidentiality Agreement (Staff)KidTraxCnfdntltyAgrmnt.pdfConfidentiality Agreement for Staff members
KidTrax Consent FormKidTraxRelease.pdfRelease of Information Consent Form
KidTrax ContractKidTraxContract.pdfReturn form to Allene Gold, Volunteer Talent Center, 330 S. Hubbards Lane, Louisville, Kentucky 40207
KRS 159051 Sch Enrolmt VrfcKRS159051SchEnrolmtVrfc.pdfComplete this form, and follow instructions
KTRS Retirement Procedures Brochurektrsretirement.pdfPrint out, complete and return to the Benefits office.
Ky Early Learning Profile Progress Report (KELP) C1 Page 1 and 2KELPC1.pdfThis form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 11", 2-part carbonless set, 2 pages. Order by Package of 25 of page 1 and 25 of page 2. Commodity Code is 5690404-1723357.
Ky Early Learning Profile Progress Report (KELP) D1 Page 1 and 2KELPD1 p1 pm7.pdfThis form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 11", 2-part carbonless set, 2 pages. Order by Package of 25 of page 1 and 25 of page 2. Commodity Code is 5690404-1723358.
Letter of Resignationresignation.doccomplete, print out, fax copy and submit original to Records Room, VanHoose
Liability Report Form - Bodily InjuryBodilyInjury.docThe principal or his/her designee must complete this form for injuries to students or visitors involving the following: death, paraplegia, quadriplegia, severe burns, severe head injuries, amputation, loss of use of a major extremity, or loss of sight, he
Liability Report Form - Property DamagePropertyDamage.docThe principal or his/her designee must complete this form if an individual notifies the school or the legal department that they are pursuing a claim against the district or a district employee for damage to the individual's personal property. This form i
Library PassLibraryPass.pdf408-2This form must be ordered from the Warehouse using MUNIS. Form is printed on a 4 1/4" x 3" White paper. Order by pads of 50 forms. Commodity Code is 5690404-1681695.
Local In-County Travel Expense VoucherIncountytravel.xlsThis form may be slow to load due to the calculation fields.
Long Term Disability Applicationmetdisabilityapp.pdfPrint out form, complete employee portion, make copies of physician statement. Have physicians complete their portion and submit to the benefits office.
Long Term Disability PolicyMETLTDPOLICY.PDFPrint out for your records
Magazine Sales Request Formmagsalesreqform.pdfComplete this form, and follow instructions
Major Summative Principal Evaluation Instructionsmajorsummative.docPrint out or download and complete
Managerial-Supervisory Employee Evaluation Form, Form A.2forma2.docPrint out or download and complete
Material Production Job Information Sheetmatprodjobreq.pdfForm must be filled out completely. Write N/A if a field on the form does not apply. Print the form and send to Material Production at C. B. Young, Jr. Service Center.
Materials Production Stationery Order Formstationeryorder.pdfThis form is interactive. Complete the form, print, and submit form by fax or pony.
Medical Conditions That May Pose a Threat in the School Environment902KAR1.170.pdf902 KAR 1:170Sample letter for notifying teachers of communicable diseases.
MetLife Voluntary Accidental Death Or Dismemberment Policymetvoltermpolicy.pdfComplete this form, and follow instructions
Metropolitan Term Life Insurance Applicationmetvoltermbrochure.pdfPrint out brochure and application, complete application and submit to the benefits department
Metropolitan Term Life Insurance Beneficiary Formmetbeneficiaryform.pdfPrint form, complete and return to the Benefits office.
Middle School ECE Progress Report and Report CardMS_ECERptCrd.pdf201-3This form must be oredered from the Warehouse using MUNIS. Form is printed on 8.5" x 14" Blue Cardstock (printed on both sides and folded). Order by packages of 50 forms. Commodity Code is 5690404-1692155.
Middle School Grade Report (Back Page)M_School_grade_Report.pdfThis form should be used to print middle school report cards from Infinite Campus. Print enough copies for each student in your building, then use those copies as the paper for the report card. This is form will then be on the back of each report card.
Middle School Interim Progress ReportMSIntrmProgRptSamp07.pdf208-2This form is utilized through Infinite Campus.
Middle School Interim Report and Report CardMSIntrmRptCard.pdf201-2Forms are generated online at schools through STI Grading Package.
Middle School Mid Year StatusMiddleSchoolMidYearStatus.pdf
Middle School Student Information—Feeder CardMidSchlStuInfoFdrCard.pdf203-2This form must be ordered from the Warehouse using MUNIS. Form is printed on an 8 1/2" x 5 1/2" White cardstock. Order by packages of 50 cards. Commodity Code is 5690404-1681706.
Middle School Yearly Summary Rpt.MSYearlySummary.pdf
MIS Request for Computer ServicesMIS-1.pdfMIS-1This form must be signed by the cost center head. Fax the signed form to the Response Center at 485-3600.
MIS Request for WebViewWebView_MIS1.pdfMIS-1This form must be signed by the cost center head. Fax the signed form to the Response Center at 485-3600.
Multiple-Receipt Form (F-SA 18)FSA_18.pdfComplete this form, and follow instructions
Name Change Formaddresschange.docComplete form, print out, sign and mail to Human Resources
Noncompetitive Negotiation  Determination And FindingDetermination_Finding.pdfUse this form when the item you are purchasing meets one of the criteria listed. Attach this form as documentation.
Notice of Significant Change in Student PerformanceNoticeofChangeSamp.pdf483-4This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 11", 3-part carbonless set Order by Package of 50. Commodity Code is 5690404-1717672.
Notice of Teacher Status - SAMPLE LetterNotice_Teacher_Status_SAMPLE_Letter.pdf
On Line ResumeOn_Line_Resume.pdfComplete this form and return to Human Resources.
Out of County Travel Expense Voucheroutofcountytravel.xlsThis form may be slow to load due to the calculation fields.
Out-of-County Student Records Request FormOut_of_CountyRecords.pdfThis is an interactive pdf form. Download to your computer and use the Save As command under File to save a form with fields completed. (DO NOT use the Save a Copy selection. This turns the form features off in Adobe Reader.)
Overtime SheetOvertimeSheet.pdf451-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 7", 2-part carbonless set. Order by Package of 50 forms. Commodity Code is 5690404-1681885.
Parent Notification - Sample LetterParent_Notification_SAMPLE_Letter.pdf
Parent Request for Info on Professional Qualification of TeacherParent_Request_Prof_Qualif_Teacher.pdf
Payment Voucher Instructions (pg 2)PaymentVoucherpg2.pdf2.pdfThis page is usually printed on the back of the voucher form. It give instructions on how to complete the payment voucher. Print the form from this site and make copies as necessary. See Generic Payment Voucher, General Fund Payment Voucher, or Grants and
pdCentral Proposal FormpdCentralProposalForm.pdfComplete this form, and follow instructions
Performance Evaluation Instructions And Forms Principalsprincipalevaltoc.docComplete this form, and follow instructions
Permanent Record Elementary and Middle School490_1PermRecord_Elem_Mid.pdf490-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 9" folder printed on all sides. Order by Package of 50 forms. Commodity Code is 5690404-2010861
Permanent Record Insert—Transfer Form: Grades 6-12PermRecInsertTransf.pdf433-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 7" white cardstock. Order by Package of 50 forms. Commodity Code is 5690404-1681720.
Permanent Record Traditional Elementary and Middle491_1_PermRecord_TradElem.pdf491-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 9" folder printed on all sides. Order by Package of 50 forms. Commodity Code is 5690404-2010860
Personal Leave for All PersonnelPersonalLeaveCard.pdf466-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 5 1/2" x 4 1/4" yellow cardstock Order by Package of 50 forms. Commodity Code is 5690404-1681722.
Personnel Policies and Procedurespersproc.pdfPrint out or download for your records
Personnel RequestPersonnelRequest.pdfComplete this form, and follow instructions
Personnel Request Formpersonnelrequestform.docPlease complete the form, print and forward it to the appropriate Human Resource personnel.
Photo ID PermissionPhotoIDCardRequest.pdfPrint out, complete and bring to Room 119 C.B. Young Service Center.
Photo-Videotape Release FormPhotoVideoRelease.pdfParent or guardian of the student should complete and sign. The form is kept on file at the school.
Physical Plant Maintenance LogPhysPlantMaintLog.pdfPrint out form, complete, and file as directed.
Physician Treatment Related to Exposure to BloodPhysicianTrtmt.pdfPrint out form, complete form, and keep form at employee's facility.
Please Admit (Slip)PlsAdmitSlip.pdf103-1This form must be ordered from the Warehouse using MUNIS. Form is printed on a 3 5/8" x 4 1/4" form on white paper. Order by pads of 50 forms. Commodity Code is 5690404-1681724.
Primary Report CardJCPSprimaryrptcd.pdf315-4Forms will be sent from Materials Production based on your enrollment plus 25%
Principal Administrative StandardsSTANDARDS.DOCPrint out or download
Principal Deficiency Evaluation Instructionsdeficiency.DOCPrint or dowload
Principal Evaluation Appeals Processappealsprocess.docPrint or download
Principal Evaluation Professional Portfolioprofportfolio.docPrint out or download
Principal Growth Plan (P-2)formp2.docPrint out or download and complete
Principal Growth Planninggrowthplan.docPrint or download
Principal Interim Summative Evaluation (P-4)formp4.docPrint out or download and complete
Principal Job Performance Evaluation Processprinintroduction.docComplete this form, and follow instructions
Principal Job Performance Evaluation ProcessPrinJobPerformEvalInstruct.docComplete this form, and follow instructions
Principal Major Summative Evaluation (P-3)p3.docPrint out or download and complete
Principal Performance Assessment Verification Formformpverification.docPrint out or download and complete
Principal Performance Evaluation Observation-Conference Summary (P-1)formp1.docPrint out or download and complete
Procedures and Report for Accepting Donations and GiftsProceduresforDonations.pdfComplete this form; fax the printed copy to Resource Development at 485-8986.
Procedures and Report for Accepting GrantsProceduresforGrants.pdfComplete this form; fax the printed copy to Resource Development at 485-8986
Procedures For Management Of Requests For Voluntary Reassignment Of Classified Support StaffProcedMgmtReq.pdfComplete this form, and follow instructions
Professional Code of EthicsCodeofEthics.pdfPrint out for your records
Professional Leave of Absenceproflvabsence.pdfPrint, complete, have signed by building principal and return to appropriate personnel specialist
Professional Leave RequestProfessLvReq.pdf445-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 5 1/2", 5-part carbonless set. Order by Package of 50 forms. Commodity Code is 5690404-1681727.
Professional Services Contract Routing FormContract Procurement Routing Form.pdfCompanion form to be included with the submission of a contract procurement form
Profit and LossProfit and Loss.pdfComplete this form, and follow instructions
Property and Equipment Loss FormInsPropEquipLossForm.pdfPrint out form, complete, and submit as directed.
Proposed Fundraising Activitiesproposedfundraisingactform.pdfComplete this form, and follow instructions
Prudential Beneficiary Form - Board Sponsored Term Life Insuranceprudentialbdbeneficiary.pdfPrint form, complete and return to the benefits office
Prudential Beneficiary Form - State Group Term Life Insurancestatebeneficiaryform.pdfPrint form, complete and return to the benefits office
Publications Order FormPublicationOrder_fm.pdfThis form is interactive. Complete this form, and mail or fax it to the JCPS Communications Department, C. B. Young Jr. Service Center, Bldg. 4. Phone: 485-3228; Fax: 485-3636.
Pupil Disciplinary Referral FormPupilDisciplReferralForm.pdf400-1This form must be ordered from the Warehouse using MUNIS. Form is printed on an 8 1/2" x 5 1/2", 4-part carbonless. Order by packages of 50 sets. Commodity Code is 5690404-1681840.
Purchase Exemption CertificatePurchaseExemptCert.pdfComplete this form, and follow instructions
Receiving TicketReceivingTicket.pdf415-1This form must be ordered from the Warehouse using MUNIS. Form is printed on a 8 1/2" x 5 1/2" yellow paper. Order by pads of 50 forms. Commodity Code is 5690404-1681735.
Record of All VisitorsRecofAllVisitors.pdfF419-1Print out form, complete, and keep on file as directed.
Record of DisclosureRecordofDisclosure.pdf443-1This form is to be printed from the JCPS Forms website. The top part of the form is interactive and may be completed on the computer and then printed. Form gets printed on 8.5" x 11" white paper.
Request for LeaveRequest_for_Leave_Form.pdfPlease complete this form and follow instructions. Upon completion submit to the Leave Center at Van Hoose room 128. Additional documentation will need to accompany this form.
Request for Leave BrochureLeaveInfoEmployees.pdfDownload and print brochure
Request for PaymentRequest_Payment_Instructions.pdfFax your completed form to Accounts Payable at 485-7036
Request for Payment to KrogerRequest_Kroger_Pay_Instruct.pdfFax your completed form to Accounts Payable at 485-7036
Request for Purchase Order Maintenance Change Notice-Vendor ChangePurchase_Order_Change.docComplete and forwarded to Accounts Payable.
Request to Return from Leavereturnfromleave.pdfPrint out, complete and return to Human Resources with appropriate documentation.
Requisition to PurchaseReqToPurchHC.pdfF-416-1Hard copy of the Requisition to Purchase form. Print this form, complete form on typewriter or by pen, and forward completed form to appropriate person or department.
Requisition to Purchase (Interactive)ReqToPurch.pdfF-416-1iHard copy of the Requisition to Purchase form. This form is interactive. Enter your information on the screen, print the form, and then forward it to the appropriate person or department.
Rules of Operation for Using pdCentralRulesOpPDC.pdfComplete this form, and follow instructions
Safe and Drug Free Schools Employee Website FlierSDFSEmployeeWebsiteFlier.pdfDownload and print flier.
Safe and Drug-Free Alcohol, Tobacco and Drugs BrochureSDFSAlcoTobacDrugsBro.pdfDownload and print brochure.
Safe and Drug-Free Assessment Center BrochureSDFSAssessCtrbro10.pdfDownload and print brochure.
Safe and Drug-Free Bullying BrochureSDFSBullying10.pdfDownload and print brochure.
Safe and Drug-Free Collateral Information FormSDFSCollateralInfoForm.pdfDownload and print form.
Safe and Drug-Free Cyberbullying BrochureSDFSCyberbullying10.pdfDownload and print brochure.
Safe and Drug-Free Gangs and Gang Violence BrochureSDFSGangs10.pdfDownload and print brochure.
Safe and Drug-Free J-CAPP BrochureSDFSJcapp.pdfDownload and print brochure.
Safe and Drug-Free Schools Office BrochureSDFSOfficebro10.pdfDownload and print brochure.
Safe and Drug-Free Schools Parent Website FlierSDFSparentwebsiteflier.pdfSchools to print and give to parents as needed.
Safe and Drug-Free Student Relations BrochureSDFSStudentRelabro10.pdfDownload and print brochure.
Safe and Drug-Free When Students Make Threats BrochureSDFSStudentThreatbro10.pdfDownload and print brochure.
Salary Schedule Admin Retired Part–TimeSalary_Schedule_Admin_Retired_Part.pdfPrint out or download for your records
Salary Schedule Certified SubstitutesSalary_Schedule_Substitutes.pdfPrint out or download for your records
Salary Schedule Extra Service – CoachesSalary_Schedule_Extra_Serv_Coach.pdfPrint out or download for your records
Salary Schedule Extra Service Pay RatesSalary_Schedule_Extra_Service_Rates.pdfPrint out or download for your records
Salary Schedule Job Family 1ASalary_Schedule_JobFamily1A.pdfPrint out or download for your records
Salary Schedule Job Family 1B SEIU CustodiansSalary_Schedule_JobFamily1B_SEIU_Cust.pdfPrint out or download for your records
Salary Schedule Job Family 1B Teamsters/Nutri ServSalary_Schedule_JobFamily1B_Teams_NutrServ.pdfPrint out or download for your records
Salary Schedule Job Family IISalary_Schedule_JobFamilyII.pdfPrint out or download for your records
Salary Schedule Job Family IIISalary_Schedule_JobFamilyIII.pdfPrint out or download for your records
Salary Schedule Job Family III & IVSalary_Schedule_Admin_JobFamilyIII_IV.pdfPrint out or download for your records
Salary Schedule Temporary SalariesSalary_Schedule_Temp_Salaries.pdfPrint out or download for your records
SBDM Special Called Meeting Media NoticeSpecCalledMeet.dotxDownload, print, complete form, and submit as directed.
School Activity Fund BudgetFSA_5.xlsFSA-5This form should be prepared for each new school year and sent to the Director of Internal Audit. A first draft is due May 15, and a final budget is due by September 30. Use the prior school year's end-of-the-year Schedule of Balances. Enter each account
School Activity Fund Expense Memorandum (Cash Advance)FSA_9.pdfFSA-9An Expense Memorandum is used in conjunction with the Standard Invoice when funds are advanced. The Expense Memornadum should be documented by proper receipts and a detail accounting of where the money was spent and the amount of the purchases. If all the
School Activity Fund Monthy Financial Report Additional InformationFSA_14D.pdfFSA-14DThis form is used to record the Accounts Receivable items and the NSF checks outstanding for each month. This form is part of the Monthly Financial Report sent to Internal Audit by the 15th of each month.
School Activity Fund NSF Check Letter to ParentNSF letter.pdfNSF Check LetterYou may use this letter when contacting the check writer of an NSF check. After writing the letter, put the NSF check in the place indicated on the letter and take a copy of the letter and send the copy to the check writer. Keep the originial letter and c
School Activity Fund Purchase RequestFSA_8.pdfFSA-8A Purchase Request is used when an original invoice is expected from the vendor. There is a time frame involved. The item or service is ordered and received. An orginal invoice is received and then paid.
School Activity Fund Ticket Seller's ReportFSA_1A.pdfFSA-1AThe Ticket Seller's Report will record the beginning and ending number on each roll of tickets to be given to each ticket seller. The color of the ticket and the price charged for the various tickets is entered along with the change given to the ticket se
School Activity Fund-Raiser SummaryFSA_2.pdfFSA-2This form is used for all Fund-Raisers held during the school year. The Inventory Summary area is completed when there is a beginning inventory, such as candy, T-shirts, etc. Compute the Expected Receipts. This will be compared to the Actual Receipts rece
School Activity Funds Standard InvoiceFSA_12.pdfFSA-12The Standard Invoice is to be used when an original invoice is NOT expected from the vendor. It is usually used for same day transactions. Detailed receipts should be attached to the Standard Invoice for documention.
School Chemical Pickup ListChemicalPickupList.pdfPrint out form, complete, and submit as directed.
School Volunteer Records CheckSchoolVolRecCheckForm[1].pdfComplete the form and submit in school/program office.
SDFS Website FlierSDFS_WebsiteFlier.pdfComplete this form, and follow instructions
Secretary HandbookSecretaryHandbook.pdfComplete this form, and follow instructions
SEIU Agreement Ext.SEIUExt.pdfComplete this form, and follow instructions
SEIUSL Sick Leave Bank Procedures And GuidelinesSEIUSLBANKPROC.PDFComplete this form, and follow instructions
Sex Offender Letter Denying Access to School GroundsSexOffDenyAccessSchoolGrds.docThis form letter may be used by a principal to deny a registered sex offender’s request to be on school grounds pursuant to KRS 17.545.
Sex Offender Letter Granting Access to School GroundsSexOffGrantAccSchoolGrds.docThis form letter may be used by a principal to grant a registered sex offender’s request to be on school grounds pursuant to KRS 17.545. The principal may grant this permission with the restrictions that the principal deems appropriate.
Short Term Disability Income Insuranceafadisability.pdfPrint and follow instructions
Small Purchase Determination and FindingSmall_Purchase_DF.pdfThis form is used when three (3) quotes are needed in order to purchase a product or a service. These can be phone or catalog quotes or written quotes when the amount exceeds the dollar limits. Attach this form as documentation.
Staff RecommendationStaffRecommendation.docPlease complete the form, print and forward it to the appropriate Human Resource personnel.
Standard Beneficiary FormStandardBeneficiaryForm.docComplete this form, and follow instructions
Standard Life Insurance Waiver of PremiumStandardTermLifeWaiver.pdfPrint out and complete and return to Rick Kirby, Reisert & Associates, 1225 Bardstown Rd., Louisville, KY 40205
Standard Student Accident Report Form (Green Card)StudntAccdntGreenCard.pdfF-442-1This form must be ordered from the Warehouse using MUNIS. This is printed on green index paper and trimmed to 4" x 6". Form is printed front and back.
Standard Term Life Insurance ApplicationStandardTermLifeApp.docPrint out form, complete and submit to the benefits department
Standard Term Life Insurance CertificateStandard Term Life Insurance CertificatePrint out for your records
State Enroll Formstateenrollform.pdfComplete this form, and follow instructions
STIPEND REPORT pdCentralSTIPENDREPORTpdCentral.pdfComplete this form, and follow instructions
Student Accident Claim FormStudAcc.pdfComplete this form. Attach bills, insurance payment records. Mail to: Bollinger Indiana P.O. box 706 Short Hills, NJ 67078-0706
Student Code of ConductStudent Code of ConductPrint agreement page and sign
Student Course Change NoticeStuCrsChgNotice.pdf107-2This form must be ordered from the Warehouse using MUNIS. Form is printed on an 8 1/2" x 5 1/2", 5-part carbonless set. Order by packages of 50 sets. Commodity Code is 5690404-1681752.
Student Information Form (formerly Student Enrollment Form)Student_Information.pdf
Student Recognition FormStudentRecognition.pdfSend Form To: Terri Robinson, Student Recognitions, Communications North, C. B. Young, Jr. Service Center, Building 4. Faxes cannot be accepted. Call Terri at 485-7654 if you have any questions.
Student Record Request Under 18StudentRecordReqUnder18.pdfComplete the online transcript request form.
Student Transcript RequestStudent_Transcript_Request.pdfComplete this form, and follow instructions
Student Transcript Request Over 18.pdfStudentTranscriptReqOver18.pdfComplete the online transcript request form.
Student-Employee Incident Report Formassault.pdfPrint out, complete and fax to appropriate departments
SubTeacher HandbookSubTeacherHandbook.pdfComplete this form, and follow instructions
Summative Evaluation, Comprehensive Assistant Principals Performance Evaluation, Form A-1forma1.docComplete this form, and follow instructions
Summative Evaluation, Comprehensive Performance Evaluation, Social Workers, Resource Teachers, Form D2formd2.docPrint out or download and complete
Summative Evaluation, Comprehensive Teacher Performance Evaluation, Form Dformd.docPrint out or download and complete
Suspension Without Pay RecommendationSUSPENDWOPAY.DOCPrint out or download and complete
Teacher Evaluation Instructionstchrevaltoc.docPrint out or download
Teacher Extra Service ReportTeacher_Extra_Service_Report.pdfAll extra service must be approved in advance and should be submitted to the Principal/Cost Center Manager. Do not submit to the Payroll Department
Teacher PDTeacherPD.htmlComplete this form, and follow instructions
Teacher Performance Criteria-Standardstchrcriteria.docPrint out or download
Teacher Performance Evaluationtchrperf019.pdfComplete this form, and follow instructions
Teacher Significant Deficiencies Noted InstructionsTchEvalSigDefeff.docComplete this form, and follow instructions
Teacher Significant Deficiencies Noted Table of Contentssigdeficiencytoc.docComplete this form, and follow instructions
Teamsters Sick Leave Bank ApplicationSickTeamstersApp.DocReturn completed form to TEAMSTERS LOCAL 783, 7711 Beulah Church Road Louisville, KY 40228
Teamsters Sick Leave Bank ProceduresSickTeamstersProcedures.pdfDownload or print out for your records
Ticket Sellers ReportTicketSellersReport.pdfComplete this form, and follow instructions
Title I TimesheetTitleI_Timesheet.docx
Tuberculosis Regulations (First-Time Registrants)TBRegultnsFirstNot.pdf476-4This form is to be printed from the JCPS Forms website. The is interactive and may be completed on the computer and then printed. Form gets printed on 8.5" x 11" white paper.
Tuberculosis Regulations: Notice of Exclusion From SchoolTBRegultnsExclnotice.pdf477-4This form is to be printed from the JCPS Forms website. The form is interactive and may be completed on the computer and then printed. Form gets printed on 8.5" x 11" white paper.
Vacancy Position Request Form VacancyPositReq.pdfThis is an interactive form. Complete the form on your computer and print copy.
Vacation Request FormVacationRequestForm.pdf462-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 11", 2-part carbonless set. Order by Package of 50 forms. Commodity Code is 5690404-1681761.
Vehicle Report FormVehReptForm04.pdfPrint out form, complete, and submit as directed.
Vendor Infor InquiryVendorInforInquiry.pdfComplete this form, and follow instructions
Verification of Custodian Floaters Reporting to Daily Assignment - PayrollPayrollVerifCustFloaters.pdfPrint out form, complete, and fax as directed.
Video Production Job RequestVideoProduction_Interactive.pdfForm is interactive. Complere and print or save. Must use at least Reader 8
Voluntary Administrative Transfer-ReassignmentVoluntaryAdminTransf.pdfPrint out
Voluntary Demotion FormVolDemotion.pdfPrint out, complete and return to Human Resources
Voluntary Reassignment Form - ClassifiedVolReassign.docComplete the form
Volunteer Auto Insurance AffidavitVolautoinsAffid04.pdfPrint out form, complete, and submit as directed.
W-9 FormW-9Form.pdfComplete this form, and follow instructions
Warehouse Withdrawal—Truck Replenishment OnlyWarehseWdrl_168_176_3b.pdf425-1This form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 5 1/2" white paper. Order by Pad of 50 forms. Commodity Code is 5690404-1681763b.
Withdrawal and Release Form—ElementaryWithdrwl_RelFormElem.pdf433-1AThis form must be ordered from the Warehouse using MUNIS. Form is printed on 8 1/2" x 11" 2-part carbonless set. Order by Package of 50 forms. Commodity Code is 5690404-1681721.
Withdrawal Form—Secondary StudentsWithdrawalSecStu.pdf104-1This form must be ordered from the Warehouse using MUNIS. Form is printed on a 8 1/2" x 11", 4-part carbonless set. Order by packages of 50 sets. Commodity Code is 5690404-1681746.
Workers CompensationWorkers_Compensation.pdfComplete this form, and follow instructions
Workers Compensation Reporting FormWcREPORTINGFORM.docPlease complete, print out and fax to the Benefits Office at 485-6256
Workers Compensation Reporting Instructionswcreportinginst.docPlease print