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Glenwood City School District

Glenwood City School District

FMLA Request / Request to use Sick Days

Request to use Sick Leave / Unpaid Leave

Insurance / Payroll Forms

Dental Information

This is for all qualified employees. The district covers 87.4% Single plan is $76.54 / $3.83 per check Family plan is $211.74 / $10.59 per check

Employee Acknowledgement Form

Flex Spending Account

Health and Well Being Plan

Health Insurance Summary - Options 1 - Wellness Completed

For Family and Single - Option 1

Health Insurance Summary - Options 1 - Wellness NOT Completed

For Family and Single - Option 1 - No Wellness

Health Insurance Summary- Options 2 - Wellness Completed

For Family and Single - Option 2

Health Insurance Summary - Options 2 - Wellness NOT Completed

For Family and Single - Option 2 - No Wellness

In Lieu of Insurance

Long Term Disability Insurance

Salary Reduction Agreement

Salary Reduction Agreement - Family Option 1

This is for Teaching Staff and 12 month Employees

Salary Reduction Agreement - Family Option 2

This is for Teaching Staff and 12 month Employees

Salary Reduction Agreement - Single Option 1

This is for Teaching Staff and 12 month Employees

Salary Reduction Agreement - Single Option 2

This for Teaching Staff and 12 month Employees

Salary Reduction Agreement - Family Option 1

This for Support Staff - 9/10 Month Employees

Salary Reduction Agreement - Family Option 2

This for Support Staff - 9/10 Month Employees

Salary Reduction Agreement - Single Option 1

This for Support Staff - 9/10 Month Employees

Salary Reduction Agreement - Single Option 2

This for Support Staff - 9/10 Month Employees

Short Term Disability Enrollment Packet

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School District of Glenwood City • 850 Maple St., Glenwood City, WI 54013 • 715-265-4266 • Fax: 715-265-4214
Copyright © 2019 Glenwood City School District. All Rights Reserved.