**Below is a list of forms for existing employees. Click links to move directly to a form. All forms are in Adobe Acrobat (PDF) format.
**Use the "Tab" key to move between fields while completing a form. please complete the form and sign where required prior to mailing or faxing. If you fax the form, please mail the hard copy so that we have your original signature.
Our mailing address is: Our fax number is: 203-854-4095
Norwalk Public Schools
Attention: HR / Talent Office
125 East Avenue
Post Office Box 6001
Norwalk, CT 06852-6001
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Please contact burrd@norwalkps.org
to report link errors. Thank you. |
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ESS Qualifying Life Event
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| Life, Dental, Vision |
FMLA (Family Medical Leave Act) |
| AETNA Beneficiary Designation Form |
FMLA for Employee |
| DELTA DENTAL ENROLLMENT FORM |
FMLA for Spouse/Family |
| Delta Dental Claim Form |
FMLA for Military |
| IPI Dental Claim Form |
FMLA Poster |
| Norwalk BOE - Vision Benefit Summary |
FMLA Employee Guide 2018 |
| Anthem Claim Form - Vision ONLY |
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| ANTHEM ENROLLMENT-MEMBER CHANGE FORM |
FSA (Flexible Spending Account) |
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FSA Plan Description 2018
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| Tax |
FSA Eligible Expenses 2018 |
Affidavit Federal 1040 Tax Form Dependent Confirmation
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FSA Enrollment Form 2018 |
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FSA Reimbursement Form 2018 |
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Health Insurance Information
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State 2.0 Brochure REV201807
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State 2.0 Partnership Plan
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State 2.0 Member Presentation REV201807
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State 2.0 Health Discount Program
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| State 2.0 Oxford Healthy Bonus |
State 2.0 Clinical Programs
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| Connecticut 2.0 Insurance Roll-Out Information |
HEP Compliance UHC - 10/1/2017 enrollment -Compliance deadline 12/31/2018
Enrollment anytime during 2018 - compliance deadline - 12/31/2019
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| State 2.0 Enrollment Form |
State 2.0 HEP Preventive Requirements |
| Instructions to Print Connecticut 2.0 Cards |
CVS Benefits at a Glance REV201807
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| State 2.0 Member Change Form |
CVS Caremark - Prescriptions |
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| Union Contracts
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Miscellaneous Forms |
| NASA Contract 2015-2018
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Personal Day Request |
| BOE - NASA Agreement 20170722 |
Request for school sponsored field trip |
| NFT Contract 2016-2019 |
Visiting or Professional Day Request |
| NFT - BOE Agreement 20170829 |
Teacher Evaluation Professional Learning Plan
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| NFT MOA re SPED Case Managers |
Administrator Request Form July 2018 |
| NFT MOA re Extended Day and Time |
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| HCE Nurse's Contract 2016-2019 |
Holiday and Weather Related Closings
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| ESG Contract 2016 - 2019 |
School Building/Office Holiday Schedule 2018-2019
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| UFT Technician's Contract 2016-2019 |
Weather Related Closings 20180322
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| UPSEU Contract thru June 30, 2020 |
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| NFEP Local 1723 2013-2017 |
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Food Service Contract thru 6-30-2020
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