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

Benefits
Gina Smith at x8475

Open Enrollment
Waiver of Benefits Form
MESSA FSA-Dep Care Information 
HSA Payroll Deduction Form  
Voluntary Life Insurance Information 
MESSA ABC Plans (List of Preventative Medications)
Enrollment Guide - ACA (ECC & LSFSS)
Enrollment Guide - Media Tech
Enrollment Guide - LSFT, LSFES, AFSCME, Adult Ed, Non Unit
Annual Notices
2024 Medicare Part D Credible Coverage Notice
Special Enrollment Rights
Annual CHIP Notice
Annual 403(b) and 457(b) Meaningful Notice/Plan Summary Information

Forms
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
    Key/Swipe Card Request

    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

    Forms
    Direct Deposit
    Dues Deduction
    LSFEE Payroll Deduction Form
    After School and Evening Assignment Request

    Investments
    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

    Taxes
    Federal W-4
    State W-4

    Employee Services
    Jeanenne Cappo at x8491

    Forms
    Address/Phone Change
    Advanced Degree (LSFT)  
    Event Form (Background Checks)
    Facility Use Request
     Field Trip Request
    FMLA Request Form 
    Childcare
    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)
    Student/Visitor Incident Report Form
    Tuition Reimbursement
    Volunteer Background Check

    Superintendent Office
    Shannon Ketelhut at x8483

    Forms
    Grapevine

    Technology Department
    Help Desk at [email protected]

    Forms
    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
    BSGT-982T-WCQKJ

    Phones
    Mitel Phones
    Retrieve Voicemails
    Setting Up Your Voicemail Box

    Live Broadcasting 
    Lake Shore Cable TV Channels
    (Only accessible in-district, on a district device)
    CBS
    C-SPAN
    Discover
    FOX
    History
    NBC
    PBS
    The Weather Channel