This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules and instructions are on page 2.
Forms for line of duty injuries
Most of the forms below are PDF files. If you encounter any problems viewing PDFs on your computer, you may need to install the free Adobe Reader software.
PLEASE NOTE: The “Application For Age 26 Young Adult Coverage” form is no longer required by the UFT Welfare Fund. Members wishing to add a dependent under age 26 to their Welfare Fund coverage at no cost should use the Welfare Fund’s online Update Your Information (Change of Status) form.
This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules and instructions are on page 2.
This legal form, which must be notarized, states that if you sue the DOE and win, you will return the money paid to you in salary for the period of your absence.
This legal form, which must be notarized, states that if you sue the DOE and win, you will return the money paid to you in salary for the period of your absence.
The DOE will reimburse you up to $100 for stolen or destroyed property, but only if the property is of the type that is normally brought into school. For reimbursement of eyeglasses damaged in assault cases, use form OP 505G.
The DOE will reimburse you up to $100 for stolen or destroyed property, but only if the property is of the type that is normally brought into school. For reimbursement of eyeglasses damaged in assault cases, use form OP 505G.
Once line-of-duty status has been approved, you can use this form to request reimbursement for out-of-pocket medical expenses to a maximum of $750.
Once line-of-duty status has been approved, you can use this form to request reimbursement for out-of-pocket medical expenses to a maximum of $750.