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Knox County Schools forms available to the public
Here are links to forms for public/business use. Employees may find other forms on the KCS Intranet.


Number/TItle Department Availability
Abdominal/Epigastric Pain: Gastroenteritis Diagnostic Guidelines - AD-H-489 (5/06) Health Services (594-3735) Download pdf
Anaphylaxis - AD-H-429 (2/02) Health Services (594-3735) Download pdf
Application for Student Transfer
AD-102 (1/11) - Available ONLY during transfer window dates February 7-21, 2011
Transfer Office (594-1502) Download pdf
2010-11 NCLB Application for Student Transfer - AD-102NCLB (7/10) Transfer Office (594-1502) Download pdf
2010-11 Student Transfer Appeal - AD-122 (9/10) Transfer Office (594-1502) Download pdf
Asthma - Self Possession of an Asthma Inhaler by a Student AD-H-485 (9/08) Health Services (594-3735) Download pdf
Authorization for News Media Contact - PA-101 (11/04) Public Affairs (594-1905) Download pdf
Body Fluid Exposure Protocol for Bites/Saliva - AD-H-307 (5/06) Health Services (594-3735) Download pdf
Burns - AD-H-407 (6/07) Health Services (594-3735) Download pdf
Chicken Pox Information - AD-H-345 (6/05) Health Services (594-3735) Download pdf
Citizen’s Request For Reconsideration of Instructional Materials - MC-114 (7/90) Media/Materials Center Download pdf
* Comment Card - PA-102 (9/06) Public Affairs (594-1905) Download pdf
Conjunctivitis Information - AD-H-322 (6/05) Health Services (594-3735) Download pdf
* Dental Insurance Enrollment/Change - BO-178 (7/09) Employee Benefits (594-1686) Download pdf
Dental Services - AD-H-472 (7/06) Health Services (594-3735) Download pdf
Diabetes Information Sheet - AD-H-360 (8/07) Health Services (594-3735) Download pdf
Diabetes Mellitus Health History - AD-H-311 (5/08) Health Services (594-3735) Download pdf
Dysphagia Swallowing Disorder Protocol - AD-H-488 (12/08) Health Services (594-3735) Download pdf
Employment Questionnaire - HR-101A (12/00) Human Resources (594-1929) Download pdf
Enrollment Requirements - Parent Letter - AD-H-383 (6/09) Health Services (594-3735) Download pdf
* Facility Permission Application for Use of School Grounds and Physical Facilities - BO-109 (8/10) NOTE: This form is 8.5 x 14 (legal). To print on MAC, select Page Setup (under file on the menu) paper size should be legal. On a PC select print, then properties and choose legal. Administrative Assistant to the Superintendent (594-1614) Download pdf
Fifth Disease (Erythema Infectious) Information - AD-H-348 (2/97) Health Services (594-3735) Download pdf
Flexible Benefit Plan Compensation Reduction Agreement - BO-106 (7/10) Employee Benefits (594-1686) Download pdf
Guidelines For Access to Electronic Media - MC-108 (9/06) NOTE: This form has been reformatted to fit on 1 page. Media/Materials Center Download pdf
Guidelines for Illness - AD-H-354B (9/07) Health Services (594-3735) Download pdf
Guidelines for Managing Life-Threatening Food Allergies - AD-H-505 (9/07) Health Services (594-3735) Download pdf
Head Lice Guidelines - AD-H-325 (3/09) Health Services (594-3735) Download pdf
* Health/Dental Enrollment Change Application (State of TN Group Insurance Program - BO-177 (1/11) Employee Benefits (594-1686) Download pdf
Heat Related Illnesses Protocol - AD-H-324 (6/05) Health Services (594-3735) Download pdf
Hepatitis A, B, and C: Learn the Differences - AD-H-471 (6/05) Health Services (594-3735) Download pdf
Hepatitis A Information - AD-H-482 (6/07) Health Services (594-3735) Download pdf
Hepatitis B Information - AD-H-483 (6/07) Health Services (594-3735) Download pdf
Hepatitis C Information - AD-H-484 (6/07) Health Services (594-3735) Download pdf
Herpes Simplex, Type I (Fever Blister) Information - AD-H-476 (7/05) Health Services (594-3735) Download pdf
How To Get There (Directions to Schools) - MO-106 (7/05) Maintenance and Operations Download pdf
Important Information About Measles, Mumps & Rubella - AD-H-313 (4/94) Health Services (594-3735) Download pdf
* KCS-TV Video Production - PA-103 (5/09) Public Affairs (594-1991) Download pdf
Leave of Absence-Continue Insurance Coverage - BO-180B
Leave of Absence-Suspend Insurance Coverage - BO-180C
Employee Benefits (594-1686) Download pdf
Management of Students with Severe Allergic Reactions - AD-H-363 (6/05) Health Services (594-3735) Download pdf
Medical Statement for Students Requiring Special Meals - FSD-49 (8/09) Food Service (594-3640) Download pdf
Mononucleosis (Mono) Information - AD-H-481 (7/05) Health Services (594-3735) Download pdf
* New Student Enrollment - CI-276 (3/10) Curriculum/Instruction Download pdf
Inscripción para de estudiantes nueuos
New Student Enrollment (Spanish) CI-276Spanish (3/10)
Curriculum/Instruction Download pdf
* Notice of Appeal of Long-Term Suspension/Expulsion (For Suspensions and Expulsions of five (5) Days or More) - CI-130 (3/09) Curriculum/Instruction Download pdf
Notice of Parent and Student Rights Under Section 504 - CI-200 (6/10) Curriculum/Instruction Download pdf
Notice of Procedural Safeguards - PP-156 (7/10) Student Support Services Download pdf
Optional Medical Release (for use with field trips) - CI-246 (5/07) Curriculumm/Instruction Download pdf
Parent Communication Form - CI-190 (5/96) Curriculum/Instruction Download pdf
Parent Feeding Questionnaire - AD-H-356 (12/08) Health Services (594-3735) Download pdf
Parent Referral to S-Team - CI-168 (10/02) NOTE: This form is 8.5 x 14 (legal). To print on MAC, select Page Setup (under file on the menu) paper size should be legal. On a PC select print, then properties and choose legal. Curriculum/Instruction Download pdf
Parental Concern - AD-T-209 (8/05) Transportation (594-1550) Download pdf
Physical Exam and Sports Medical Permission - CI-191ABC (1/09) Curriculum/Instruction Download pdf
Physical Examination and Immunization Information - AD-H-395 (2/09) Health Services (594-3735) Download pdf
Physician Form for Administration of Medication and Self Medication Administration - AD-H-326 (7/09) Health Services (594-3735) Download pdf
Physician's Order for Ventilator Settings - AD-H-511 (8/09) Health Services (594-3735) Download pdf
* Physician’s Verification of Illness and/or Maternity Leave - HR-102 (3/09) Human Resources (594-1929) Download pdf
Pinworms Information - AD-H-327 (6/07) Health Services (594-3735) Download pdf
Poison Ivy/Oak (Contact Dermatitus) Information - AD-H-346 (6/05) Health Services (594-3735) Download pdf
* Pre-K Application 2010-11 (594-1755) - CI-111 (3/10) Curriculum/Instruction Download pdf
*Proof of Residence for School Enrollment - AD-109 (3/10) Attendance/Transfer Office (594-1502) Download pdf
*Prueba de la residencia para la inscripción de la escuela - AD-109Sp (3/10) Attendance/Transfer Office (594-1502) Download pdf
Protocol for Dental Concerns - AD-H-443 (5/02) Health Services (594-3735) Download pdf
Recommended Guidelines for Injuries and Illness Requiring First Aid and/or Emergency Care - AD-H-354A (8/07) Health Services (594-3735) Download pdf
Reference Guide for Ventilator Alarms - AD-H-510 (8/09) Health Services (594-3735) Download pdf
Release of Claims for Future Accidental Injuries - CI-194 (2/05) Curriculum/Instruction Download pdf
Release/Authorization to Publish - PA-100 (11/04) Public Affairs (594-1905) Download pdf
Review of Assessed Fee (Facility Permission) - BO-124 (6/99) Administrative Assistant to the Superintendent (594-1614) Download pdf
Ringworm Information - AD-H-344 (8/07) Health Services (594-3735) Download pdf
Scabies Information - AD-H-347 (8/07) Health Services (594-3735) Download pdf
School Bus Complaint - AD-T-211 (8/05) Transportation (594-1550) Download pdf
* Security Flex 125 Program Medical/Dependent Care Reimbursement Program Claim - BO-179AB (7/09) Employee Benefits (594-1686) Download pdf
Seizure Description - AD-H-493 (8/07) Health Services (594-3735) Download pdf
Seizure Disorder Protocol - AD-H-365 (7/08) Health Services (594-3735) Download pdf
Shigellosis Information - AD-H-391 (8/07) Health Services (594-3735) Download pdf
Shingles (Herpes Zoster) Information - AD-H-486 (6/07) Health Services (594-3735) Download pdf
Skin Rash Information - AD-H-350 (6/05) Health Services (594-3735) Download pdf
Sore Throat Information - AD-H-328 (2/02) Health Services (594-3735) Download pdf
Special Education Services Available Through Knox County Schools - PP-155 (1/10) Student Support Services
(594-1540)
Download pdf
Strep Throat Information - AD-H-349 (6/05) Health Services (594-3735) Download pdf
Student Intern Background Information - HR-130 (11/10) Human Resources (594-1929) Download pdf
Student Medical Profile - CI-277 (8/09) Curriculum/Instruction Download pdf
Perfil Médico Estudiantil del Condado de Knox (Student Medical Profile) CI-277Sp (8/09) Curriculum/Instruction Download pdf
* Travel Expense Reimbursement Request for Private Schools - BO-134P (1/11) Finance Office Download pdf
Vagus Nerve Stimulation Protocol - AD-H-453 (6/07) Health Services (594-3735) Download pdf
* Vision Insurance Enrollment/Change - BO-176 (7/09) Employee Benefits (594-1686) Download pdf
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