District Forms

Accounts Payable
Amy Schehr at x8473

Mileage Reimbursement
Request for Check
Internal Account Request for Check

Cash Handling
Field Trip, Fundraiser, or Event Log

Gina Smith at x8475

Open Enrollment
Instructions for Open Enrollment 2024
Benefits and Costs 2024
Benefits and Costs for 2024 - ACA Eligible
Waiver of Benefits Form

MESSA FSA-Dep Care Information 
HSA Plan Information
HSA Payroll Deduction Form
MESSA Online Benefits User Guide 
Voluntary Life Insurance Information 
MESSA ABC Plans (List of Preventative Medications)

Annual Notices
2023 Medicare Part D Credible Coverage Notice
Special Enrollment Rights
Annual CHIP Notice
Annual 403(b) and 457(b) Meaningful Notice/Plan Summary Information

Madison National Life Insurance Beneficiary 
FSA Dependent Care Withdrawal Request
FSA Medical Withdrawal Request
Waiver of Group Benefits
Voluntary Life Insurance Enrollment
Voluntary Life Insurance Evidence of Insurability 
Vision Out-of-Network Reimbursement 

Summary Plan Descriptions
MESSA ABC & 3 Tier RX - Plan 1 w/Mandatory Mail
MESSA ABC & 3 Tier RX - Plan 2 Coins 20%
MESSA Choices & 3 Tier RX - 20% Coins w/Mandatory Mail
Essentials by MESSA - PPO
MESSA Dental Plan
MESSA Vision Plan
  • Madison National Life 

  • Maintenance and Operations Department
    Maintenance Request Form

    Payroll Department
    Donna Wertheimer at x8474

    Office of Retirement Services
    (800) 381-5111

    Employee Portal
    Link to Website
    Employee Portal Quick Reference Guide
    Employee Portal First Time Use
    Instructions for Downloading Check Stubs

    Direct Deposit
    Dues Deduction

    LSFEE Payroll Deduction Form
    After School and Evening Assignment Request

    403b Newsletter Introduction
    403b Employee Newsletter
    403b Salary Reduction Agreement
    457 Agreement 
    TSACG – Third Party Administrator for all 403b & 457 Plans

    Payroll Schedule
    2024-25 Payroll Schedule

    Federal W-4
    State W-4

    Employee Services
    Jeanenne Cappo at x8491

    Address/Phone Change
    Advanced Degree (LSFT)  
    Event Form (Background Checks)
    Facility Use Request
    Field Trip Request
    FMLA Request Form 
    Leave Request (Contractual)
    LSFT After School & Evening Assignment Form
    LSFT Teaching Supplies ($50)
    Mileage Reimbursement
    MISD SCECH Application
    Name Change Form
    Professional Development Request 
    Request for Bus Transportation
    Staff Requisition and Change Form (Administrators Only)
    Tuition Reimbursement
    Volunteer Background Check

    Superintendent Office
    Shannon Ketelhut at x8483


    Technology Department
    Help Desk at [email protected]

    Hardware Request
    Software Request
    Acceptable Use Policy

    Windows 10 Resources

    Windows 10 Beginners Guide
    Quick Steps to Setup Your Desktop for Windows 10
    Keyboard Shortcuts for Windows 10
    Quick Reference Sheet for Windows 10
    Windows 10 Training

    Windows 10 Resources
    Dell Purchase Program
    Journey Ed

    Discovery Education
    Schoology Course

    Mitel Phones
    Retrieve Voicemails

    Live Broadcasting 
    Lake Shore Cable TV Channels
    (Only accessible in-district, on a district device)
    The Weather Channel