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Name *

First

Last

School entity *

Phone *

Email *

EMPLOYEE WAGES:

Total number of employees with wages more than $10,000 *

Tax Collectors are NOT eligible for Unemployment Compensation and should not be included in above number.

Total number of employees with wages less than $10,000 *

Tax Collectors are NOT eligible for Unemployment Compensation and should not be included in above number.

Total wages paid to employees with less than $10,000 *

Tax Collectors are NOT eligible for Unemployment Compensation and should not be included in above number.

Please upload documentation for above figures *

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Please combine documents into one PDF document

services. above services

Please Note: If you use the CSIU Payroll System, there are two reports set up that will provide the information needed:

Unemployment Comp/File (this is a detailed report; the last page shows totals and must be run by quarter) report tag pyucqtr - you need to select "print reports only." Return a copy of the last page showing totals for each quarter in 2024 and list the number of total employees for each quarter.
Unemployment Comp/PSBA report tag pyucpsba. Attach a copy of this report. This shows the $10,000 cap payroll as well as the employee count.

WAGE SUMMARY DOCUMENTS:

Please upload copies of the 941 wage summary pages for all four quarters of 2025.

If you have all four quarters saved as one document, please upload it in the Q1-941 form section below.

2025 Q1-941 form

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2025 Q2-941 form

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2025 Q3-941 form

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2025 Q4-941 form

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Please upload any additional documents as needed

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ADDITIONAL DISTRICT DATA:

Do you anticipate any restructuring or reduction of revenue sources resulting in layoffs in the upcoming school year (2026-2027)? *

Have you experienced any staff reductions, other than regular seasonal, in the last 36 months? *

What restructuring or reduction of revenue sources resulting in layoffs do you anticipate? *

What staff reductions, other than regular seasonal, have you experienced in the last 36 months? *

What services do you currently outsource? *

Bus Driver
Substitutes
Food Services
Maintenance/Custodial
Other

Select all that apply.

If you selected "Other," please describe your other outsourced services.

What services do you anticipate outsourcing in the upcoming school year (2026-2027)? *

Bus Driver
Substitutes
Food Services
Maintenance/Custodial
Other

Select all that apply.

If you selected "Other," please describe your other outsourced services.

TERMS AND CONDITIONS

The information provided on this application form has been confirmed by all necessary parties within this organization to be true, accurate, and complete to the best of our knowledge. We acknowledge that any misrepresenation will result in immediate cancellation of service. *

I Agree

Who should the contract be sent to? Please provide 2 people with emails. *

Signature *

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