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Form #	Form Title
1040	Certificated Request to Return From Leave (Administrative)
4214	Request for Administrator Assignment Action
9161-A	Request to Announce Non school Administrator Vacancy
9161-B	Request for Administrator Assignment Action (non-school based)
9161-C	Request to Announce School-Based Administrator Vacancy
9161-D	Request for School Based Administrator Assignment
9161-E	Administrator Position - Learn School Selection
1436	Applicant Roster - Certificated Management Position Opening
6115	Request for Transfer - School Based Administrator

Form #	Form Title
1220	Clear and Professional Credential Renewal Affidavit
1282	Current Contracted Employees Informational Form
1441	Occupational Therapist/Physical Therapist Renewal Affidavit
9059-2	Procedures for Teachers Converting to Inter / Probationary Contract Status
9024-3	Conversion Non-Confidential Reference
1510	Middle School Authorization (Authorization to teach subject grades 6-8 based on university coursework. No fee required).
1007-4	Board Permit (Authorization to teach a subject at a high school based on university coursework. No fee required).
1708	Application for Committee on Assignments Authorization
8766-2	Emergency 30 Day Substitute Teaching Permit Affidavit

Form #	Form Title	Form Description
8424	Authorization to Release Tuberculosis Clearance Information
8457 & 8459	Certificate of Medical Examination & Tuberculosis Clearance	Verification of TB and health clearance. To be completed by a physician after selected for employment as a teacher or substitute.

Form #	Form Title
8000	Affidavit Regarding Change of Name
8040	Change of Name Request
	Change of Address Form

Form #	Form Title
1024	Evaluation of Instructional Personnel - Initial Planning Sheet
1025	Evaluation of Instructional Personnel - Observation / Conference Sheet
1044	Evaluation of Certificated Management Personnel - Initial Planning Sheet.
1049	Evaluation of Certificated Management Personnel - Observation / Conference Sheet
1072	Evaluation of Service Personnel - Initial Planning Sheet
1073	Evaluation of Service Personnel - Observation / Conference Sheet

Form #	Form Title	Form Description
7024	Administrative Transfer Request	To transfer a certificated employee from one location to another. Needs local district superintendent approval.
9051	Administrator Extra Duty Pay Form	Extra duty pay for administrators working outside their regular assignment.
13676-2	Categorical Limited Contract	To contract an employee who provides certificated services to schools that are participants in one of the Categorically funded programs.
1065	Certificated Request for Leave of Absence	Request for a leave of absence for specified reasons and period of time.
1038	Certificated Request to Return from Leave	Form to return to work after an approved leave of absence.
8152	Certificated Resignation Form and Instructions
8414	Community Representative Application	For employees who serve in an unclassified position as an advisor or consultant to the District.
	Confidential Separation Questionnaire
8942	Non-Classroom Waiver Form	To transfer from a location identifying the replacement and staff balance, if applicable.
8938	Non-Routine Payment Request Form
1421	Notice of Outstanding Service of Certificated Employee
8937	Notification of Displacement	Notice to inform a teacher in the event there is an over-teachered condition where there are more qualified teachers than positions at a school / program.
Memo S-41	Off-Track Teacher Available to Substitute Form	Form used to evaluate teachers at a specific location who want to substitute during off-track time.
8239	Physician's Statement for Certificated Personnel Leave of Absence	Formal approval from physician, if applicable.
3167	Professional Expert Application	Allows a school or office to employ a qualified person on a temporary basis for a unique and non-repetitive or specific project.
	Reduced Workload Leave Packet
1765	Request for Auxiliary Teachers
1006	Request for Emergency Credential / Permit
9985	Request for Extended Illness Benefit - 10/90 Application
9073	Request for Personnel Action (RPA)	Enables a school or office to budget a position that is not norm generated.
8415	Student Aide Application	To employ a full-time student in an unclassified position part-time.
4132-5	Teacher Reassignment Information
7761	Teacher-Initiated Transfer Program	Provides a probationary or permanent teacher a vehicle to transfer to another location. (Refer to Memo 4551)
	Voluntary Displacement Form
7762	Continuous Service Transfer Program 2009-10	Provides teachers with permanent or continuing status who meet certain conditions (refer to MEM-4640) eligibility to transfer to another location.
	Professional Expert Assignment Request Form	Administrators who are interested in requesting approval for a professional expert assignment (refer to BUL-4305).
	Request for Changes in Assignments and Salaries

Form #	Form Title	Form Description
1087	Confidential Reference Form	Reference form to be submitted by all applicants not currently employed by LAUSD.
3776	Elementary Coursework Sheet	For non-certificated / licensed elementary school applicants. Used to list courses to qualify for Emergency, Pre-Intern and Intern teaching permits.
2602	Non-Confidential Reference Form	Reference form to be submitted by all applicants who are currently employed by LAUSD in any capacity.
9034	Conversion Non-Confidential Reference Form	Form used to evaluate K-12 teachers employed under a temporary contract.
2136-7	Psychiatric Social Worker Application Packet	Forms for Psychiatric Social Worker applicants
	Pupil Services and Attendance Counselor Application Packet	Forms for PSA Counselor applicants
6087	Report of Conviction / Pending Criminal Court Cases	To be completed by applicants who have pending criminal court cases or have been convicted, fined, placed on probation, or given a suspended sentence regardless or dismissal or expungement.
1088	Report of Evaluation of Less Than Satisfactory Service	To be completed by applicants who have received a less than satisfactory service evaluation
	Retiree Application Packet	Forms for retired applicants
2019	Secondary Coursework Sheet	For non-certificated / licensed secondary school applicants. Used to list courses to qualify for Emergency, Pre-Intern and Intern teaching permits.
1086	Teacher Employment or License Denial Cases	To be completed by applicants who have been denied a previously requested teaching license or have been denied employment due to an adverse action.
8457 & 8459	Certificate of Medical Examination & Tuberculosis Clearance	Verification of TB and health clearance. To be completed by a physician after selected for employment as a teacher or substitute.

Form #	Form Title	Form Description
3134	U-Form - Application for point credit approval or degree differential from an accredited institute of higher learning	Application for salary point credit for coursework completed at accredited colleges and universities subsequent to rating in. May also be used to submit coursework for Multiculture credit and to register a masters and / or doctorate degree(s).
3308	S-Form - Supplemental application for training and experience	Supplemental application for training and experience credit completed prior to rating-in for a new employee who has already submitted the A&B rating-in forms.
3128	M-Form - Application for multicultural credit	Application for verification of completion of the requirements for multicultural study, including previously submitted coursework for which salary point credit has been granted.
3127	NA-Form - Application for point credit approval for proposed study in non-accredited schools including foreign institutions	Application for salary point credit for study completed in non-accredited schools including foreign institutions.
3141	T-Form - Instructions for Education Travel Project	Instructions and pre-approval from for Educational Travel Credit (pre-approval must be obtained to receive salary credit).
3115	N-Form - Application for Reimbursement Approval	Pre-approval form for Teacher Recruitment & Student Support grants for math, science or special education teachers serving at Decile 1, 2, or 3 K-12 schools. Reimbursement will be based on educational expenses (tuition and books) related to the degree or credential.
3116	R-Form - Application for Reimbursement	Reimbursement Approval Form used to submit with verification of educational expenses (tuition and books) related to the degree or credential for Teacher Recruitment & Student Support grants for math, science or special education teachers at Decile 1, 2, or 3 K-12 schools.

Visit the Risk Management Website to Acess these forms	Form Title
	Certificated Request to Return from Leave
	Benefits and Responsibilities of Employee Injured as a Result of an Act of Violence
	Special Physical Injury (Act of Violence Report) to be filled out by Administrator
	Employee Report of Incident or Work Related Injury / Illness On-The-Job
	Alleged Act of Violence / Injury Check List
	Act of Violence
	Supplemental Report of Injury

Form #	Form Title
1080	Certificated Day-to-Day Substitute Teacher Service Report
2139	Request for Extended Day-to-Day Substitute Online Form
8938	Non-Routine Payment Request Form
8766-2	Emergency 30-Day Substitute Teaching Permit Affidavit
MEM-4693	K-12 Teacher Summer Substitute Registration
MEM S-41	Off-Track Teacher Available to Substitute Form