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Forms, Notices and Disclosures

Forms, Notices and Disclosures

Please note:  Each form or document 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.

2024-2025 Income & S-EBT Survey

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 an Income & S-EBT Survey (formerly called the 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 Income & S-EBT Surveys as possible.
 
We are asking all parents to complete theIncome & S-EBT Survey 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 Income & S-EBT Survey  through PaySchools.  However, if you would prefer to complete a hard copy of the application, please download the application from this link: Income & S-EBT Survey 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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Dispensing Medication Forms

These forms apply to students in PS through 12th grade.
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Ohio School Health Physicians Report

(Required physical form for entry into Kindergarten)
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Parent and Teacher Referral Forms

Ohio’s dyslexia support laws (ORC 3323.25 and 3323.251), allow both parents and teachers to refer students for tier 1 dyslexia screening. Teachers that refer students must also receive parent permission before any screening can occur. 
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Transparency in Health Care Coverage

In order to comply with Transparency in Coverage Rules regarding self-funded health insurance, UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of Fairfield Union Local Schools.


To link to the Machine-Readable Files, please click on the URL provided:    transparency-in-coverage.uhc.com

Continuity Plan - June 2021

Required Elements of a Local Plan

  1. Policies for Mitigation Strategies: Plan for incorporating eight different mitigation strategies included in current CDC guidance.
  2. Continuity of Services: Plan to address academic and non-academic services for students and staff.
  3. Periodic Review: Review at least every 6 months through September 30, 2023 and revise plan as appropriate.
  4. Public Input: Seek public input and incorporate revisions as necessary.
On June 2, 2021, Governor DeWine announced the state’s loosened mask mandate. Fully vaccinated people in Ohio will no longer be required to wear a mask except in certain crowded indoor settings, such as healthcare and transportation. Governor DeWine has requested that schools and districts design plans that address the safe return to in-person instruction and continuity of services to meet the needs of students.
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Local Use of Funds Plan - August 2021

Local Use of Funds Plan 

School District: Fairfield Union Local Schools

District Contact: Courtney Roberts, Treasurer - Email Courtney Roberts Phone: 740-536-7384

Prevention and Mitigation Strategies – CDC Guidelines:

  • The district will continue to purchase cleaning supplies and masks for teachers and students on an as needed basis to encourage the strong recommendation of wearing masks and following sanitization and distancing protocols.

 Address Impact of Lost Instructional Time:

  • The district will compensate teachers and support staff to conduct an After School program to provide aide to students needing extra help from teachers as well as credit recovery.  
  • The district will also hold a Summer Enrichment program that focuses on continual teacher / student contact throughout the summer months.  
  • Employ additional staff in Math in order to hold a Math Lab at the high school level.
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