Peninsula School District Forms On-Line

Anyone: If a link is available to the form, you can click on that link, print the form yourself
or save it to your hard drive and fill in the blanks or complete as necessary.   

In-District Staff: Type your order, print & send in the pony
or send an email to kotlark@psd401.net
with Your Name, Building, and the name & quantity of each type of form you are ordering. 
The district office receptionist will collect the ordered forms & send them to you.

If you have any suggestions for additions or changes on forms, please email kotlark@psd401.net
Use CTRL+F to find a form listed below  

Name: Building:

	AP Transmittal Form - ASB
	AP Transmittal Form - GF
	Application For Duplicate Instrument Affidavit
	AR01 - Reconciliation of Revolving Checking Accounts
	AR02 - General Fund
	AR03 - Transmittal of General Fund Receipts
	AR04 - Transmittal of ASB Receipts
	AR05 - ASB Purchase Order
	AR06 - ASB Fund / Interactivity Transfer
	AR07 - ASB Budget Transfer
	AR08 -  PSD Agreement between ASB's
	AR09 - ASB Fund Raiser Form
	AR10 - ASB Monthly Financial Statement (Elementary)
	AR11 - ASB Monthly Financial Statement (Secondary)
	AR12 - Contract for ASB Fund Raiser
	AR13 - ASB Imprest Account Replenishment Request
	AR16 - ASB Payment Order - pad of forms
	AR17 - PSD Collection Detail - pad of forms
	AR18 - Outside Billing Request Form
	AR19 - RevFund CHECK REQUEST form
	AR20 - JV Journal Voucher Form
	ASB01 - ASB Budget Transfer
	ASB02 - ASB Fund Interactivity
	ASB03- ASB Fund Transfer
	ASB07 - ASB Payment Order
	ASB11 - ASB Refund Ticket
	ASB30- ASB Interact Transfer
	A - ATHLETIC FORMS ATHLETIC PACKET Directions for completion of packet Concussion Information Sheet District Attendance Policy PSD Athletic Eligibility Check List Required Athletic Info Pre-participation History Physical Form RELEASE/SAFETY GUIDELINES Baseball/Softball Basketball Cheerleading Football Golf Soccer Swimming Tennis Track Volleyball Weightlifting Weight room Wrestling X-Country   Non-PSD Student Athlete non-PSD Student Athlete Form Coaches Off Season Hours Documentation
	AWARDS
	Awards - Ellen Fay Award Directions & Nomination Form, Ellen Fay Prior Awards
	Awards - Mary Lee Squires Award Directions & Nominations Form,  Mary Lee Squires Teamwork Award Info  Mary Lee Squires Prior Awards
	Board Agenda Item Form
	Board Information Item Form
	Certificate of Insurance Request Form - SUP01 - Certificate of Insurance Request Form
	Certificate of Insurance for Chapel Hill Facility Use
	Certificate of Insurance for BANNER - City of Gig Harbor
	Classified Professional Growth Funds
	Classified Comp Form
	Clock Hour Proposal Form         Vita Form            (Judy Williamson) CLOCK HOUR CREDITS - Registration
	COUNSELORS
	Counselor Extra Day Form
	SFAT Referral Form
	SFAT Referral Status Sheet
	CHILD ABUSE
	Child Abuse Form
	COURSE REVIEW
	Course Review Procedures
	Course Review Request
	Community Resources - 20 pages (Updated by Gail Brandt)
	ENROLLMENT FORMS: Emergency/Enrollment Form - each student every year                               Sample Student Reunification Process:  safe/StudentReleaseSAMPLE.doc New Student Information - half sheet - new students to building Enrollment - Special Transportation Request - only if needed Health Care Resources Health Info Survey Health Report History of Ear and Hearing Problems Photo & Directory Restriction Form Immunization - Requirements/Kindergarten Immunization Requirements/Preschool Enrollment Report
	English Language Learners Program   ELL - Parent Permission for Assessment        English - Parent Permission for Assessment        Chinese - Parent Permission for Assessment        Korean - Parent Permission for Assessment        Russian - Parent Permission for Assessment        Spanish - Parent Permission for Assessment        Ukrainian - Parent Permission for Assessment ELL - Parent Notification of New & Continuing Student Placement       English - Student Placement form       Chinese - Student Placement form       Korean - Student Placement form       Russian - Student Placement form       Spanish - Student Placement form       Ukranian - Student Placement form ELL - Home Language Survey WA State Transitional Bilingual Program        English Forms/ESL/English.doc        Korean http://www.peninsula.wednet.edu/support/Forms/ESL/Korean.pdf        Russian http://www.peninsula.wednet.edu/support/Forms/ESL/Russian.pdf        Spanish http://www.peninsula.wednet.edu/support/Forms/ESL/Spanish.pdf        Ukrainian http://www.peninsula.wednet.edu/support/Forms/ESL/Ukrainian.pdf        Vietnamese http://www.peninsula.wednet.edu/support/Forms/ESL/Vietnamese.pdf ELL - Eligibility Service/Waiver form ELL - Service Request or Waiver - Elementary ELL - Service Request or Waiver - Middle ELL - Service Request or Waiver - High ELL - Parent/Teacher Conference Notice       English - Parent/Teacher Conference Notice       Chinese - Parent/Teacher Conference Notice       Korean - Parent/Teacher Conference Notice       Russian - Parent/Teacher Conference Notice       Spanish - Parent/Teacher Conference Notice       Vietnamese - Parent/Teacher Conference Notice ELL - Exit Form      English - ELL Exit Form
	Facility Use - Field Use Guidelines: http://www.peninsula.wednet.edu/support/FIeldGuidelines.htm
	Facility Use Application
	Facility Use Classification & Fees
	Facility Use Guidelines
	Facility Use Application - In District Form
	Facility - Winterfest - Tidefest -Booth  Artist / Vendor Booth Application - Use Agreement Facility - Winterfest - Tidefest - Childcare http://www.peninsula.wednet.edu/support/Forms/ChildCareInfo-Form.doc
	Facility - PHS Winterfest Artist / Vendor Booth Application - Use Agreement
	Facility - GHHS Tidefest Artist / Vendor Booth Application - Use Agreement
	Facility - Volunteer Facility & Grounds Improvement Projects
	Facility - Building Condition Report
	Facility Use - Short Term Insurance - Contact Facilities Use 858-5524
	Fax Cover Sheet - SUP24
	First Aid Registration Form 2009- 2010
	FLYER DISTRIBUTION REQUEST
	Request to Post Flyers form
	Grant Application - Peninsula Schools Education Foundation
	HEALTH FORMS/NURSES
	Asthma: Medication Request and Treatment Plan
	Health Concern Bus Form
	Nurse Extra Day Timesheet
	Parent Permission for Over-The-Counter (OTC) Medication at School
	Physician's Order for Medication at School
	Epi Pen Physician Order Form
	Hazardous Waste Disposal Process
	Hazardous - Chemical Monitoring
	HOME SCHOOL
	Home School - Declaration of Intent to Home School PartTime Attendance/Ancillary Services
	H - HUMAN RESOURCES FORMS: P1 - Position Authorization
	P2 - Change of Employment
	P4 - Supplemental Position Authorization
	P5 - Recommended Candidate
	Job Sharing Application
	Harassment-Discrimination Complaint Form
	Sexual Harassment Reporting
	H - EVALUATION FORMS Teacher Level 1 Evaluation Process Cover Page Introduction Responsibilities Professional Goals Worksheet, Form B Formal Observation, Form C Evaluation, Form D Standards, Addendum A, Teachers Standards Rubric, Addendum B, Teachers Teacher Level 2 Evaluation Process Cover Page Introduction Responsibilities Professional Goals Worksheet, Form B Professional Goals Verification, Form E Standards, Addendum A, Teachers Standards Rubric, Addendum B, Teachers ESA Level 1 Evaluation Process Cover Page Introduction Responsibilities Professional Goals Worksheet, Form B Formal Observation, Form G Evaluation, Form H Standards, Addendum B, ESAs ESA Level 2 Evaluation Process Cover Page Introduction Responsibilities Professional Goals Worksheet, Form B Professional Goals Verification, Form I Standards, Addendum B, ESAs Principal Eval Cover & Instructions Goal Setting Evaluation Classified Staff Classified Staff Evaluation Form Coaches Co-Curricular Head Coach Evaluation Co-Curricular Middle School Coach Evaluation Assistant Coach Evaluation Substitute Teacher Evaluation Substitute Teacher Evaluation Substitute Classified Evaluation Substitute Classified Evaluation
	PERS21 - Donate Sick Leave.doc  & DonateSLCriteria
	H EmployeeDonationSharedLeave
	H EmployeeRequestSharedLeave
	PEA FORMS PEA BAAPStipendSuppContract.doc PEA EnhancedResponsibilityStipend.pdf PEA Salary Schedule
	INTERNS
	Intern - Teacher Application
	Intern - ESA Application
	Legal - Request for Public Records / Public Information Request Form
	Legal - Student Rights & Responsibilities Letter
	Legal - Discipline Chart Guidelines
	Legal - Languages Important Information Please Read
	Legal - Truancy Petition 2009 TEMPLATE
	Legal - Truancy Progress Report TEMPLATE 2009
	Legal - Becca Letter TEMPLATE 2009
	Legal - Truancy additional documents October 2009
	Legal - BECCA Conference Letter 2009
	Common Schools Provisions RCW 28A
	LEG01  - Suspension Form - Short Term
	LEG02 - Suspension Form - Long Term
	LEG03 - Suspension - Emergency Expulsion Forms
	MAINTENANCE FORMS: Maintenance - MasterKeyDeliveryRecord.doc Maintenance - PesticideNotification.doc
	MILEAGE FORMS: Mileage - Artondale Mileage - Discovery Mileage - Evergreen Mileage - Gig Harbor Mileage - Goodman Mileage - Harbor Heights Mileage - Harbor Ridge Mileage - Henderson Bay Mileage - Key Peninsula Mileage - Kopachuck Mileage - Minter Mileage - Peninsula Mileage - Purdy/ESC Mileage - Vaughn Mileage - Voyager Mileage - Technology Services
	Notary Public Application     Notary Log
	Parent / School Authorization for Employment of a Minor
	Parent Permission Form for R-rated videos
	Pierce County Community Services Resource Guide 2005/2006.
	Print Shop Request Form - District Office Use  - Buildings must use NCR form - contact Joe at PrintShop
	PAYROLL FORMS: Pay01 - Direct Deposit
	Pay02 - Timesheet - Classified
	Pay03 - Timesheet - Certificated
	Pay05 - Leave Record
	Pay06 - Mid-Month TimeSheet
	Pay10 - Sick Leave Buyback Form
	Pay20 -  IRS Forms
	Benefit Book: SUMMARY OF BENEFITS
	Pay - Flexible Plan Enrollment Form
	Pay - Flexible Plan Reimbursement Form 08-09
	Pay - Flexible Plan Reimbursement Form 09-10
	Pay - Group Pay Roster - Certificated
	Pay - Group Pay Roster - Classified
	Pay - Donated Sick Leave Form
	Pay - Salary Reduction Agreement Form
	Pay - Information Change Form
	POLICIES on-line: http://www.peninsula.wednet.edu/board/policy/default.asp
	PURCHASING FORMS:
	Direct Order - Elementary Schools
	Direct Order - Secondary Schools & ESC Dept.
	Direct Order - ASB
	Professional Service Agreement
	Addendum to Personal Services Agreement
	Federal Contracting for Professional Services
	Requisition
	W-9
	Request to Increase PO
	Air Travel Request
	Travel Card Request
	UPS Form - Shipment Request
	Surplus Book Form
	Surplus CPU and Printer Form
	Surplus Furniture and Equipment Form
	Small Works Roster Application
	Reimbursement Form
	Travel Reimbursement Claim Form
	Sales Receipt Form
	QSD Form Side 1 - EP1
	QSD Form Side 2 - EP2
	Radio Problem Report / Radio Order Form- HandHelds
	Radio Assignments
	Records for Archive                    Records for Shredding
	Report Card Forms
	Revolving Fund Reconciliation
	SAFETY FORMS: SAF - SAFETY - Risk Management Frequently Asked Questions
	SAF00 - Risk Management Incident Reporting Process         or   Workers Comp Reporting Process
	SAF01-  Risk Management Incident Report Form (Student / Parent / Theft / Property Damage)
	SAF02 Employee  SIF2 Self Insured Form (required- only if medical or time loss)
	SAF03  Employee / Workers & Supervisor Accident Report Form / PSWCT REQUIRED
	SAF05 Physicians Initial Report
	SAF15.doc    Report of Hazard
	SAF20 - Indoor Air Quality Complaint Form
	SAF20B - Indoor Air Quality Incident Report Form
	SAF21 - Staff Emergency Information Cards
	SAF22 - Building Safety Inspection Report
	SAF FIELD TRIP FORMS Field Trip Permission Form Overnight Trips Risk Management recommended sites:  - Dept.of State Travel  http://www.state.gov/travel/  - US State Department website for foreign travel -    helpful to share with staff & students traveling to China - Travel Tips Field Trip Transportation Request Form SAF31 - Volunteer Driver Checklist (Field Trip Form) Students Driving Students SAF30A - http://www.peninsula.wednet.edu/support/forms/studentsTransport.htm
	SAF32 - Special Events Liability Insurance Form - PTA's or other groups can use
	SAF40 - Animals in Schools
	Animals in Schools 3-14-05
	Visiting Animal Form
	SAF50 - Vocational Shop Safety Inspection Form
	Safety Orientation
	Safety Bulletin Board POSTING Requirements
	Safety Committee Members - First Aid Card Holders
	Safety/Emergency Drill Reporting Form
	Safety / Emergency Drill Schedule - Reporting Form
	Senior Projects
	Staffing Paper Form - SUP23
	Student Insurance - mail-in forms available at all buildings, contact office managers or safety@psd401.net StudentInsuranceEnrollment.pdf StudentInsuranceClaimForm.pdf Student Insurance Company Website: http://www.myers-stevens.com/index.php?module=pForms&func=All
	STUDENT SERVICES
	Student Services - Transition Student Information Summary
	Student Services - Transition Information Sheet
	Student Services - Transition Information Team Report
	Student Services - Transition Elementary to Middle Transfer Checklist
	Student Services - Transition Middle to High Transfer Checklist
	Student Services - Request for Interpreter
	Student Services - Special Ed Bus Form
	Student Services - Competency 14 Initial Verification Form
	Student Services - Competency - Continuing Form
	Student Services - Social Worker Extra Day Timesheet
	Student Services - Psychologist Extra Day Timesheet
	TRAVEL FORMS: Please Note: Due to budget restrictions for the 2009-2010 school year, no out of state travel will be approved if the travel cost involves any district funds (i.e.: paying for subs, mileage, meals, accommodations, travel etc…). All travel expenses must be covered in full by the individual and/or group. Travel Forms - Leave & Release Time Request / Travel Authorization - SUP21 PS Travel Form - Out of State Board Approval Form - SUP20
	TRANSFER FORMS: Request to Transfer Within PSD Request for Release - Choice Application for Non-Resident Admission
	Transp - In-Lieu-of-Transportation-Form
	Work Order Form - Technical Support

Please contact me as soon as possible regarding this matter.

Other needs or notes:

kotlark@psd401.net