Staff

Staff Forms

Medical

Dental Plan Benefits Description

Dental Enrollment Form

Dental Claim Form

Dental Student Coverage Questioniare

Davis Vision Personal Representative Designation

Vision Reimbursement Form

District Notice to Employees

Empire Plan EPO Guide

Empire Plan PPO Guide

Family and Medical Leave Act Absence Request

Family and Medical Leave Act Form

Family and Medical Leave Act WH-380

Flexible Spending Plan Reimbursement Voucher

Medical Claim Form

Medical Designation of Representation

Medical Enrollment Form

Medical Enrollment Form - Spanish

Medical Individual Authorization Form

Medical Membership Form

Medical Student Coverage Questionnaire

Prescription Drug Claim Form

Prescription Drug Mail In Form

Payroll

Direct Deposit Agreement

Emergency Form

Employee Retirement System Membership Registration

Employment Eligibility Verification I-9

ERS Designation of Beneficiary

Holiday Fund

NYS IT 2104

Omni 403b Information

Omni Group 403b

Substitute & Part Time Employee Retirement Form

Teacher Retirement System Application

TRS Designation of Beneficiary

W4

Other Documents

Defensive Driving Reimbursement

District

Attendance & Tutor Reimbursement

Conference Form & Expense Report

Facilities Use Form

Field Trip Request

Food Reimbursement

Mileage Reimbursement 2017

Mileage Reimbursement 2018

Per Diem Claim Form

Sports Claim Form

Vendor Claim Form

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Contact Us

Fallsburg Central School District
115 Brickman Road
Fallsburg, NY 12733
Phone: 845-434-6800
Fax: 845-434-8346

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Junior Senior High School
115 Brickman Road
PO Box 124
Fallsburg, NY 12733
Main Office: 845-434-6800
Fax: 845-434-0168

Benjamin Cosor Elementary School
15 Old Falls Road
PO Box 123
Fallsburg, NY 12733
Main Office: 845-434-6800
Fax: 845-434-0871

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