Forms

Rushville Middle School
6409 Cincinnati-Zanesville Road NE
Lancaster, OH 43130
Phone: 740-536-7249
Fax: 740-536-7211

ADA Compliance

Each form is listed twice. The first is in PDF format. The second is an RTF file which is required for compliance with the Americans with Disabilities Act.

Middle School Forms

Archived News

2024-2025 Free and Reduced-Price School Meals Application

All enrolled students of Fairfield Union Local Schools are eligible to receive a healthy breakfast and lunch at school at no charge to your household each day of the 2024-2025 school year. No further action is required of you. Your child(ren) will be able to participate in these meal programs without having to pay a fee or submit a Free and Reduced Meal Application. However, to secure Federal Title funds for educational programs across the District, it is critical for the District to collect as many Free and Reduced Meal Applications as possible.

We are asking all parents to complete the Free and Reduced Meal Application that is available in your PaySchools account. The direct link to the PaySchools (lunch account) system is: PaySchools Central LogIn Page.

We appreciate your willingness to complete the Free and Reduced Meal Application through PaySchools. However, if you would prefer to complete a hard copy of the application, please download the application from this link: Free and Reduced Meal Application 2024-2025.pdf or contact your child(ren)’s school for a copy of the application. For questions regarding eligibility, parents can refer to this document: Income Eligibility Guidelines

Additional questions regarding our Food Service program should be directed to the Food Service Director, Diana Browning, at the District Office. You can also email Mrs. Browning at [email protected].

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Completely fill out part 1 - Student /Applicant Information. The student’s parent/guardian must complete and sign this portion.
Complete pledge of employer section.
- Make sure to include the Employer’s Tax ID Number and tentative hours/days to be worked
- Your employer must sign the pledge of employer section.

Student must have a current physical form filled out by a doctor (page 2 of the application).
- Physicals are active for 1 year from the date performed. If there is a current athletic physical on file, we can use this. If not, page 2 must be presented with a doctor’s signature.

After completing steps 1-4, you have two options:
- Bring the completed forms to the cashier’s office between the hours of 7:30 a.m. and 2:00 p.m. The student needs to be present to sign the official work permit. OR
- Email copies of the completed work permit application to Kathy Williams ([email protected]) and you can complete the process virtually. (Home printing capabilities required.)

Print the application form here Work Permit Application Forms.

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Forms

ADA Compliance

Middle School Forms

2024-2025 Free and Reduced-Price School Meals Application

Dispensing Medication Forms

Immunization Exemption Form

OHSAA Pre-Participation Physical

Open Enrollment Application

Student Accident Insurance Plans 2023-2024

Work Permit Application and Process