Applications & Forms

The links below will contain forms in various formats for use by/for MSAD #11 school district. Please check with each building for school building specific forms.

Employment Applications

Teacher and Ed Tech III Application

Non-Teaching Application

Coaching Application

School Health Coordinator Application

M.S.A.D. # 11 Employee Payroll / Human Resource Forms

Payroll / Human Resource Forms for M.S.A.D. # 11 employees. Any questions regarding the forms should be directed to Andrea Disch, Payroll /Human Resources Supervisor.

Health / Dental Insurance Forms

Health / Dental Insurance forms for M.S.A.D. # 11 employees. Any questions regarding the forms should be directed to Andrea Disch, Payroll /Human Resources Supervisor.

Anthem MEA Group Health Insurance Benefit Comparison

Anthem Group Health Insurance Benefit Grid - Plans Effective July 1, 2005

Anthem MEA Group Health Insurance Enrollment / Change Form

Completed Anthem Group Health Insurance Enrollment/Change Forms should be forwarded to Andrea Disch at the Superintendent's Office.

MSMA Group Dental Enrollment/Change Form

Completed MSMA Group Dental Enrollment/Change Forms should be forwarded to Andrea Disch at the Superintendent's Office.

W-4 2006 Employee's Federal Withholding

Completed W-4 Forms should be forwarded to Andrea Disch at the Superintendent's Office.

W-4ME State of Maine Employee's Withholding Form

State of Maine Employee Withholding Form

Maine State Retirement System Forms

MSRS forms for members of the Maine State Retirement System

An Overview of MSRS Benefits for Teacher Members

The information in this handbook is intended to give you a general understanding of benefits available to members of the Maine State Retirement System (MSRS).

An Overview of MSRS Disability Benefits

The information in this handbook is intended to give you a general understanding of disability benefits available to members of the Maine State Retirement System (MSRS).

An Overview of MSRS Group Life Insurance Program

The information in this handbook is intended to give you a general understanding of the MSRS Group Life Insurance benefits available to members of the Maine State Retirement System (MSRS).

MSRS Change of Beneficiary Group Life Insurance

Use this form to change your designation of beneficiary(ies) under the Group Life Insurance Program administered by the Maine State Retirement System (MSRS).

After you have completed this form, mail it to the Group Life Insurance Program at the address printed at the top of the form.

If you are a member of the MSRS, please note that this form does not pertain to MSRS pre-retirement death benefits. You must change your beneficiary(ies) for your MSRS pre-retirement death benefits separately.

Certification Links and Information

Certification Chairperson Laurie Leavitt: (lleavitt@msad11.org)

Other Links:

Form Links:

The attached forms are to interactive documents in Microsoft Word files or to Acrobat PDF files. If you have Microsoft Word installed then downlaod these, fill out the information required, save your changes and email the changes back to Laurie Leavitt. If you do not have Microsoft Word then you can print the form from the handbooks and send them to Laurie Leavitt at the Gardiner Area High School by inter-office mail.

If you do not have Acrobat Reader installed then you can download it from http://www.adobe.com. Apple's Preview application on a Macintosh computer will open PDF files as well.