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Arlington Central School District

Medical Form Information

Mailing and contact information for Arlington medical forms.
Return completed forms to the:

Arlington Central School District
144 Todd Hill Road
LaGrangeville, NY 12540
Attn: Human Resources
Secure Fax: 845-350-4188

If you have any questions, contact the Human Resources at 845-486-4460.

COVID-19 Forms and Information

Employee Request for Covid Paid Sick Leave and/or Remote Work

Revised Employee Request for Paid Covid Sick Leave - August 30.pdf 340.28 KB (Last Modified on September 1, 2021)

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Request for Family or Medical Leave

Your Rights Under FMLA

FMLA Attendance Verification Form

Medical Form for Personal Illness

Medical form for Family Member's Health Condition

Additional Medical Related Forms

Workplace Accommodation Form

Workplace_Accommodation_Forms_20210816.pdf 1.09 MB (Last Modified on April 10, 2025)

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Medical Information-Records Release Authorization

Form - Medical Release.pdf 141.69 KB (Last Modified on July 17, 2024)

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Cancer Screening Leave Form

Cancer Screening leave form.pdf 222.52 KB (Last Modified on May 30, 2023)

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Sick Bank Request Form

Form_Sick_Bank_20210713.pdf 809.1 KB (Last Modified on April 21, 2023)

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