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

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
ACA-AF1 Sexual Harassment Under Title IX – Report of Sexual Harassment
ACA-AF2 Sexual Harassment Under Title IX – Intake Form
ACA-AF3 Sexual Harassment Under Title IX – Formal Complaint of Sexual Harassment under Title IX
ACA-AF4 Sexual Harassment Under Title IX – Notice of Formal Complaint of Sexual Harassment
ACA-AF5 Sexual Harassment Under Title IX – Determination of Responsibility
ACA-AF6 Sexual Harassment Under Title IX – Notice of Dismissal of a Formal Complaint
ACA-AF7 Sexual Harassment Under Title IX – Appeal of Determination of Responsibility
ACA-AF8 Sexual Harassment Under Title IX – Notice of Appeal
ACA-AF9 Sexual Harassment Under Title IX – Decision on Appeal
ADF-AF1 District Wellness Program – Wellness Policy Implementation Evaluation
ADF-AF2 District Wellness Program – Indicator Grids

B INDEX-AF
BBB-AF1 School Board Elections 
1E (Public Notice of Filing)
2E (Public Notice of Filing-Independence 30 School District)
BBB-AF2 School Board Elections 
1K (Candidate Declaration)
2I (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
1D (Application for a Vacated Board Position)
2D (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

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

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

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
EF-AF1 Food Service Management – Nondiscrimination in School Nutrition Programs
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

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

G INDEX A-F
GBA-AF1 Exempt and Nonexempt Employees – Compensatory Time
GBAD-AF1 Telework
GBBDA-AF Family and Medical Leave – New Employee Notice of Family and Medical Leave Act Rights and Responsibilities
GBCBB-AF1 Protected 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

THERE ARE CURRENTLY NO ADMINISTRATIVE FORMS IN THIS SECTION.

PLEASE RETAIN THE TAB FOR POSSIBLE FUTURE USE.

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 – Lau Plan
IGBI-AF1 Home Schooling – Written Declaration of Enrollment
IGCD-AF1 Virtual Courses (Request to Enroll in MOCAP or District-Sponsored Virtual Courses)
IGCD-AF2 Virtual Courses (Enrollment Approval for MOCAP or District-Sponsored Virtual Courses)
IGCD-AF3 Virtual Courses (Enrollment Denial for Non-MOCAP Virtual Courses)
IGCD-AF4 Virtual Courses (Enrollment Appeal for MOCAP and District-Sponsored Virtual Courses)
IGCDA-AF4 MOCAP Virtual Courses (MOCAP Virtual Course Enrollment Denial)
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

J INDEX-AF
JCB-AF1 Transfers Within the District – 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
JFG-AF1 Searches of Students
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
JGGA-AF1 Seclusion, Isolation and Restraint – Parent/Guardian Notification
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
JO-AF9 Student Records – Nondisclosure Agreement
JO-AP2 Student Records – Disclosure of Photographs, Images and Recordings Maintained by the District

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

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