Frequently Requested Forms

This page contains links to frequently requested forms in the district, including academic, athletic, health, food services, enrollment, volunteering and contacting the board of education.

Enrolling and Open Enrollment

Intradistrict Building Transfer Request (Previously 'Open Enrollment')

This form is for parents to request that their children be allowed to attend school in a building in a different attendance area than the one they would normally be enrolled in based on where the student lives.

2017-18 form

2018-19 form

Health and Medical

Asthma Action Plan

Please complete both forms below as needed for medication administration:

Request for administration of medication by school personnel

Asthma Emergency Action Plan

If you have any additional questions, please contact your school nurse.

Student Insurance

Pickerington Schools has made arrangements with Student Protective Agency to provide optional student accident insurance for those wishing to purchase coverage this year.

Please note that this is a strictly voluntary student accident insurance coverage that the district makes available to parents as a courtesy.  The full cost of the premium is paid by the parent/guardian. If there is a claim during the student day, the claim must be certified by a school official. If the claim happens during a non-school 24-hour period or over the summer, the parent completes the claim.


Application (PDF) | Application (RTF)


Please note the coverage shown on the application. Covered losses less than $250 are paid without regard to other insurance.

Senior high football coverage requires an additional premium. All other school supervised sports are covered under the plan. On claims over $250 this is an excess coverage policy for which benefits are payable only for that part of the loss not covered by other collectible insurance. If a person has no other insurance, the company will pay the covered medical expenses incurred within one year, up to the specified limits of the policy.

Complete the application and check the boxes for coverage desired. Tear off and keep the rest of the application, as it shows not only the coverage but the exclusions and limitations of the policy.

Mail the applications directly to Student Protective Agency, 300 Coshocton Avenue, Mount Vernon, OH 43050 along with a money order of check payable to Student Protective Agency. The school will be notified as to who takes out coverage. You can call Student Protective Agency at 800-278-2544 for more information.

In case of an accident the student or parent should immediately go to the building principal who will sign and provide the claim form if only school time coverage is taken out. 24-hour coverage needs no signature. The policy number shall be provided by the school for the claim or you can call 800-278-2544. You may give that policy number to the doctor or hospital but the bills should be sent to the parent or guardian who attach them to the claim form. Once completed, mail to the claims office at Guarantee Trust Life Insurance, PO Box 1148, Glenview, IL 60025.

If you have any further questions regarding a claim, please call 1-800-622-1993. It is the responsibility of the parent or guardian to file the claim.

Tdap Immunization (Required Before Grade 7)

Immunization letter and physician’s form – grade 7 (PDF)

Immunization letter and physician’s form – grade 7 (RTF)

Per the Ohio Department of Health, all 7th graders must show documentation of receiving a Tdap immunization before being allowed to enter school next year.

Previously, Pertussis (the “P” in the immunization) had not been required after the age of 7. Due to an increase in outbreaks of Pertussis (also known as Whooping Cough) the Department of Health has decided that a booster is needed.

You may take this letter with you to your doctor to use as documentation of this vaccination, or you may submit an immunization report with the dates of this Tdap vaccination. Please return this documentation as soon as possible to your child’s school nurse. If this is not provided during the 6th grade school year, you will need to send this information to the Junior High that your child will attend, prior to the beginning of next school year. The middle school nurses will forward on all immunization documentation received to the junior high nurses at the end of this year.

Immunizations Prior to Grade 12

Immunization letter and physician’s form – grade 12 (PDF)

Immunization letter and physician’s form – grade 12 (RTF)

Per the Ohio Department of Health, all 12th graders must show documentation of having received 2 doses​ ​of​ Meningococcal​ ​(MCV4)​ immunization before being allowed to enter school next year. This is a new requirement for this age group.

The second dose must be administered after the 16th birthday. If the 1st dose of MCV4 was administered on or after the 16th birthday, a 2nd dose is not required.

Food Services

Free and Reduced-Price Meals Information

Free/reduced-price meals: Your children may be eligible for free or reduced-price meals. If you wish to apply for meal benefits, please read the instructions below and complete the application. Fill out the federal application online or download, print, and complete the applicationUse one application for all students in your household. We cannot approve an application that is not complete.



Change of Bus Stop

If there is a change that needs to be made regarding your student’s pick-up or drop-off sites, please log in to the online system and click on the “Parent Communication” link.


Volunteer in Our Schools

Individuals interested in volunteering in our schools must fill out a volunteer application and submit it to a building principal.