The following is a list of printable forms for employees. All forms are Adobe (.pdf) files. You will need Acrobat Reader to view and print them.

***Some of the forms should be printed on colored paper as indicated. The Unit Office greatly appreciates your cooperation.

2017 Open Enrollment Insurance Information
PC EaseCentral Login
Insurance Comparisons
Open Enrollment Memo
New Fort Dearborn Life Summary
– New Fort Dearborn Life Highlights
Fort Dearborn Term Life and AD&D Employee Benefits Booklet

– Std #1 POS-C 1500h Rx8 Benefit Summary
Std #2 PPO 2500c Rx8 Benefit Summary
HSA #1 POS HSA 1750a Rx12 Benefit Summary
– HSA #2 PPO HSA 5000h Rx12 Benefit Summary
HSA #3 POS HSA 5000c Rx13 Benefit Summary

Health Alliance Provider Directory
Be Healthy
Now What?
Rxtra $0 drugs
Rxtra Flier
Treatment Cost Calculator

Dental Benefit Summary
Dental Benefit Booklet
Dental Maximum Rollover Explanation
Generic Dental ID
Vision Benefit Summary
Vision Provider Search *Vision Plan – choose VSP, Vision Network – choose VSP Choice Network
Vision Pre-Enrollment Support
Vision 16-17 Proposal
Vision Plan – Additional Notes
Guardian VSP Vision ID Card *NEW*
Section 125 Flexible Benefits Summary Plan Description

IMRF Voluntary Additional Contributions Fact Sheet
Paycheck Deductions and Benefits Explanations

403b Vendors

Community Fund Payroll Deduction

CPDU Application
CPDU Form – May 3, 2017
CPDU Form – April 12, 2017
CPDU Form – February 17, 2017
CPDU Form – August 16, 2016
CPDU Form – January 15, 2016
CPDU Form – August 21, 2015
CPDU Form – January 16, 2015
CPDU Form – August 19. 2014
CPDU Form – January 17, 2014

Direct Deposit Authorization
Employee Accident Report
Employee Time Sheets
Graduate Course Approval Form
Graduate Course Reimbursement Form
Incident Report – to be used for visitor/student injury on school property

Personal Leave (Green Paper)
Professional Leave (Goldenrod Paper)
Report of Absence (Blue Paper)
Request for Reimbursement of Monthly Travel Expenses
Unpaid Leave
Withholding Allowances – IL-W-4 and W-4

IMRF Total Compensation Package
SY2017 Administrator and Teacher Salary and Benefits Report
Superintendent Contract 2013-2017

COBRA Coverage Initial Notification