Sample Administrative Forms

MSBA forms are models that may be fully customized by any member district. MSBA’s Full Maintenance service does not include customization of forms.

Contact

Policy
Matt O’Brien – Editor, Basic and Policy Online
573-445-9920, ext. 347
obrien@mosba.org

SECTION A: FOUNDATIONS AND BASIC COMMITMENTS

A		INDEX-AF
AC-AF1		Prohibition against Discrimination, Harassment and Retaliation – Notice of Nondiscrimination
AC-AF2		Prohibition against Discrimination, Harassment and Retaliation – Grievance Form
AC-AF3		Prohibition against Discrimination, Harassment and Retaliation – Level I Grievance Report
AC-AF4		Prohibition against Discrimination, Harassment and Retaliation – Level II Grievance Report
AC-AF5		Prohibition against Discrimination, Harassment and Retaliation – Level III Grievance Report
AC-AF6		Prohibition against Discrimination, Harassment and Retaliation – Appeal Form
ADF-AF1		District Wellness Program – Wellness Policy Implementation Evaluation
ADF-AF2		District Wellness Program – Indicator Grids

SECTION B: SCHOOL BOARD GOVERNANCE AND OPERATIONS

B		INDEX-AF
BBB-AF1		School Board Elections – Public Notice of Filing
BBB-AF2		School Board Elections 1J (Candidate Declaration) 2H (Candidate Declaration for Urban Districts)
BBB-AF3		School Board Elections – Acknowledgment Candidate Received Required Information
BBB-AF4		School Board Elections – Notice of Candidate’s Obligation to File a Financial Interest Statement 1C (District has NOT adopted MSBA policy BBFA, certified the policy and mailed it to the Missouri Ethics Commission biennially by the statutory deadline) 2E (District has adopted MSBA policy BBFA, certified the policy and mailed it to the Missouri Ethics Commission biennially by the statutory deadline)
BBB-AF5		School Board Elections – Sample Letter to Clerk or Election Authority When No Election is Held
BBB-AF7		School Board Elections – Designation of Personal Representative for Candidates with Disabilities or on Active Military Duty
BBB-AF8		School Board Elections – Verification of Ballot Order via Personal Representative for Candidates Filing by Certified Mail
BBE-AF1		School Board Vacancies – Application for a Vacated Board Position 1B (Application for a Vacated Board Position) 2B (Application for a Vacated Board Position – Urban Districts)
BBE-AF2		School Board Vacancies – Notice of Appointed Member’s Obligation to File a Personal Financial Disclosure Statement 1B (District has NOT adopted MSBA policy BBFA, certified the policy and mailed it to the Missouri Ethics Commission biannually by September 15 AND has an operating budget of over one million dollars) 2C (District HAS adopted MSBA policy BBFA, certified the policy and mailed it to the Missouri Ethics Commission biannually by September 15 AND has an operating budget of over one million dollars)
BBF-AF1		School Board Member Ethics
BBFA-AF2		Board Member Conflict of Interest and Financial Disclosure – Statement of Substantial Interest
BCA-AF1		Board Organizational Meeting – Board Member Oath of Office
BDDA-AF1		Notification of Board Meetings – Notice of Open Public Meeting
BDDA-AF2		Notification of Board Meetings – Notice of Closed Meeting
BDDL-AF1		Release of Information – Request to Examine and/or Copy District Records

SECTION C: GENERAL SCHOOL ADMINISTRATION

C		INDEX A-F
CBG-AF1		Evaluation of the Superintendent – Superintendent Performance Improvement Plan

SECTION D: FISCAL MANAGEMENT

D		INDEX A-F
DG-AF1		Depository of Funds – Bank Depository Services Bid Notice and Specifications
DG-AF2		Depository of Funds – Depository Bid Sheet for Current School Year
DG-AF3		Depository of Funds – Depository Contract and Pledge Agreement
DJF-AF1		Purchasing – Card Usage Agreement – Employee
DJF-AF2		Purchasing – Card Usage Agreement – Board Member
DJF-AF3		Purchasing – Purchase Documentation
DJF-AF4		Purchasing – Affidavit
DLB-AF1		Salary Deductions – Payroll Deduction Authorization – Meal Charges

SECTION E: SUPPORT SERVICES

E		INDEX A-F
EB-AF		Safety Program – Facility Safety Inspection Report
EBBA-AF1		Illness and Injury Response and Prevention – Emergency Information Form – Student
EBBA-AF2		Illness and Injury Response and Prevention – Emergency Information Form – Employee
EBBA-AF3		Illness and Injury Response and Prevention – Incident Report
EBBA-AF4		Illness and Injury Response and Prevention – Log of Attempts to Contact Parent/Guardian
EEA-AF1		Student Transportation Services – Transportation Request Form
EEA-AF2		Student Transportation Services – Proof of Vehicle Liability Insurance for Volunteers
EGAAA-AF1		Reproduction of Copyrighted Materials – Copyright Notices
EGAAA-AF2		Reproduction of Copyrighted Materials – Request for Off-Air Video Recording
EGAAA-AF3		Reproduction of Copyrighted Materials – Interim Designation of Agent to Receive Notification of Claimed Infringement
EHB-AF1		Technology Usage – Parent/Guardian Technology Agreement
EHB-AF2		Technology Usage – Student User Agreement
EHB-AF3		Technology Usage – Employee Technology Agreement
EHB-AF4		Technology Usage – External User Technology Agreement
EHBC-AF1		Data Governance and Security – Confidentiality and Security Agreement for Employees and Volunteers

SECTION F: FACILITIES DEVELOPMENT

F		INDEX A-F
FEF-AF1		Construction Contracts Bidding and Awards – Statement of Volunteer Construction Worker

SECTION G: PERSONNEL

G		INDEX A-F
GBA-AF1		Exempt and Nonexempt Employees – Compensatory Time
GBBDA-AF		Family and Medical Leave – New Employee Notice of Family and Medical Leave Act Rights and Responsibilities
GBCBB-AF1		Staff Communications (Notice to Employees -Section 105.055)
GBE-AF		Staff Health and Safety – Accommodations Information Form to Physician
GBEBA-AF		Drug-Free Workplace – Notice
GBEBC-AF		Criminal Background Checks (Employee Background Check Consent)
GBH-AF		Staff/Student Relations – Parent/Guardian Notice of Electronic Communications with Students
GBL-AF1		Personnel Records – Certificated New Employee Information
GBL-AF2		Personnel Records – Non-Certificated New Employee Information
GBL-AF3		Personnel Records – Ethnicity and Race Staff Self-Identification Form
GBL-AF4		Personnel Records – Beneficiary Designation
GBLB-AF1		References – Authorization to Provide Employment Information
GBLB-AF2		References – Notice of Disclosure of Allegations of Sexual Misconduct with a Student
GBM-AF1		Staff Grievances – Grievance Initiation Form
GBM-AF2		Staff Grievances – Grievance Findings
GBM-AF3		Staff Grievances – Appeals of Formal Grievance Decisions
GCBC-AF		Professional Staff Fringe Benefits – Acknowledgment of Receipt of Employee Benefits Package
GCBDA-AF1		Professional Staff Leaves – Professional Leave Application Form
GCD-AF1.1C		Professional Staff Recruiting and Hiring – Job Vacancy Notice
GCI-AF.1B		Professional Staff Assignments and Transfers – Request for Transfer
GCPB-AF.1A		Resignation of Professional Staff Members – Checklist Following Termination or Resignation of Employment
GDBC-AF.1A		Support Staff Fringe Benefits – Acknowledgment of Receipt of Employee Benefits Package
GDI-AF.1B		Support Staff Assignments and Transfers – Request for Transfer
GDN-AF1.1A		Evaluation of Support Staff
GDPB-AF.1A		Resignation of Support Staff Members – Checklist Following Termination or Resignation of Employment

SECTION H: NEGOTIATIONS

THERE ARE CURRENTLY NO ADMINISTRATIVE FORMS IN THIS SECTION.

PLEASE RETAIN THE TAB FOR POSSIBLE FUTURE USE.

SECTION I: INSTRUCTION

I		INDEX-AF
IGAEB-AF1		Teaching about Human Sexuality – Provider Affirmation
IGB-AF1		Accommodation of Students with Disabilities (Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards)
IGB-AF2		Accommodation of Students with Disabilities (504 Eligibility Determination)
IGBC-AF1		Parent and Family Involvement and Engagement (District Title I Parent and Family Involvement and Engagement Plan)
IGBC-AF2		Parent and Family Involvment and Engagement (School Title I Parent and Family Involvement and Engagement Plan)
IGBCA-AF1		Programs for Homeless Students – Assignment to a School Other than School of Origin/School Requested by the Parent
IGBH-AF1		Programs for English Language Learners – Student Home Language Survey
IGBI-AF1		Home Schooling – Written Declaration of Enrollment
IGCD-AF1		Virtual Courses (Request to Enroll in Virtual Courses)
IGCD-AF2		Virtual Courses (Virtual Course Enrollment Determination)
IGD-AF1		District-Sponsored Extracurricular Activities and Groups – Application for Approval of Clubs or Groups
IGD-AF2		District-Sponsored Extracurricular Activities and Groups – Semester Declaration for Home-Schooled Student Participation in MSHSAA Governed Activities
IGD-AF3		District-Sponsored Extracurricular Activities and Groups – Mid Semester Declaration for Home-Schooled Student Participation in MSHSAA-Governed Activities
IGDA-AF1		Student-Initiated Group Use of District Facilities
IGDF-AF1		Student Fundraising – Fundraising Approval Form
IIAC-AF1		Instructional Media Centers/School Libraries – Consent for Disclosure of Library Records
IICA-AF1		Student Field Trips and Excursions – Permission Slip and Medical Release Form
IICA-AF2		Student Field Trips and Excursions – School-Related Student Trip Request Form
IKF-AF1		Graduation Requirements – Request for Credit
IKFA-AF1		Early Graduation

SECTION J: STUDENTS

J		INDEX-AF
JCB-AF1		Intradistrict Transfers – Application for Change in School Assignment
JEC-AF1		School Admissions – Proof of Residency Form
JECA-AF1		Admission of Students – Request for Waiver
JECA-AF2		Admission of Students – Registration Form
JFCC-AF1		Student Conduct on School Transportation – Bus Driver’s Report
JFCF-AF1		Bullying – Bullying Incident Report Form for Required Reporters (Employees, Substitutes and Volunteers)
JFCF-AF2		Bullying – Bullying Incident Report Form for Use by Parents, Students and Community Members
JFCL-AF1		A+ Schools Program – A+ Participation Agreement
JG-AF1		Student Discipline – Receipt of Student Handbook
JG-AF2		Student Discipline – Initial Referral
JG-AF4		Student Discipline – Letter for Suspensions of Ten or Fewer Days
JG-AF5		Student Discipline – Letter for Suspensions of Ten or Fewer Days and Recommendation of More than Ten Days
JG-AF6		Student Discipline – Letter for Suspensions of 11-181 Days
JG-AF7		Student Discipline – Superintendent Review/Hearing Preparation Checklist
JG-AF8		Student Discipline – Acknowledgment of Request for Hearing
JG-AF9		Student Discipline – Letter to Parents Recommending Suspension of More than 181 Days or Expulsion
JG-AF10		Student Discipline – Letter to Parents Recommending Expulsion
JG-AF11		Student Discipline – Notice of Charges for Suspension Greater than 180 Days or Expulsion
JG-AF12		Student Discipline – Waiver of Right to Hearing
JG-AF13		Student Discipline – Final Administrative Adjudication
JG-AF14		Student Discipline – Expulsion Notice
JGB-AF1		Detentions and/or In-School Suspension of Students – Notification to Parent/Guardian
JGF-AF1		Discipline Reporting and Records – Reporting Agreement with Law Enforcement
JHCD-AF1		Administration of Medications to Students – Permission Form for Student to Self-Administer Medication
JHCD-AF2		Administration of Medications to Students – Permission Form for Medications
JHCD-AF3		Administration of Medications to Students – Physician Certification
JK-AF1		Work Certificates – Principal=s or Designee=s Self-Certification to Issue Work Certificates
JO-AF1		Student Records – FERPA Release
JO-AF2		Student Records – Record of Requests for Information
JO-AF3		Student Records – Request to Amend Education Records and Request for a Hearing
JO-AF4		Student Records – Response to Hearing
JO-AF5		Student Records – Request for Education Records
JO-AF6		Student Records – Transfer of Records to School Student is Currently or Prospectively Attending
JO-AF7		Student Records – Conditions for Disclosure of Student Records to Officials and Authorities of the State Juvenile Justice System
JO-AF8		Student Records – Letter to Parent Regarding Receipt of a Subpoena

SECTION K: SCHOOL-COMMUNITY RELATIONS

K		INDEX A-F
KG-AF1		Community Use of District Facilities – Application for Permit to Use District Facilities
KL-AF		Public Concerns and Complaints (Concern or Complaint to the Board)
KLA-AF1		Concerns and Complaints Regarding Federal Programs – Concern or Complaint to the Superintendent
KLB-AF		Public Questions, Comments or Concerns Regarding District Instructional/ Media/Library Materials – Request for Reconsideration of Materials

SECTION L: EDUCATION AGENCY RELATIONS

THERE ARE CURRENTLY NO ADMINISTRATIVE FORMS IN THIS SECTION.
PLEASE RETAIN THE TAB FOR POSSIBLE FUTURE USE.