end of year exit forms - katy independent school district of year exit paperwork.pdf · end of year...

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INSTRUCTIONS FOR COMPLETING END OF YEAR EXIT PAPERWORK

** DO NOT PRINT DOUBLE SIDED ** USE BLUE OR BLACK INK ONLY

1. EMPLOYEE PAYOFF AND BENEFIT ELECTION FORM• Please read all instructions and choose the appropriate option.• NOTE: For additional questions on this form please contact RISK

MANAGEMENT at 281.396.2241.

2. EXIT REPORT FORM• Complete TOP PORTION ONLY. (An accurate mailing and email address

is imperative.)

3. CHANGE OF ADDRESS, PHONE NUMBER, STATUS FORM• This form is to be COMPLETED ONLY if there are changes to your

address, phone number or status upon exit with Katy ISD. Otherwise, youmay disregard this document.

Documents should be returned to Human Resources by one of the following ways: • Email to exitpaperwork@katyisd.org• In person at the Education Support Complex Annex• Interoffice mail to Human Resources Department• By mail to 438 FM 1463 Katy, TX 77494

For additional assistance with the exit process, you may contact:

• PROFESSIONALSo Tracey Sherrill – 281.396.2351 or exitpaperwork@katyisd.org

• PARAPROFESSIONALS & AUXILIARYo Ana Reyes – 281.396.2374 or exitpaperwork@katyisd.org

HUMAN RESOURCES DEPARTMENT EMPLOYEE PAYOFF AND BENEFIT ELECTION FORM FOR EMPLOYEES WHO WORK 226 DAYS OR LESS 

 

House Bill 973 entitles school district employees to continue benefits through the summer months of a given 

school year if they resign or retire effective after the last day of instruction. Katy ISD is in compliance with that 

legislation and will continue elected benefits for all employees according to their choice.  

Retiring or resigning employees who work 226 days or less per year but are paid on a 12‐month basis may 

request an early payoff. Katy ISD can grant your request but the district needs to verify your requested payoff 

date and how your benefits are to be handled.  

 

Please choose the date of your final paycheck and when you want to end your benefits in the boxes below 

 

 

 

 

 

 

 

 

 

 

 

 

 

___________________________  ________________    ____________________        Printed Employee Name     Employee Number        Date 

  ___________________________  ________________________        Employee Signature               Position/Title    

 If you have questions regarding HB 973, you may call the KISD Risk Management Department at 281‐396‐2241.  

 

Option 1 

______ NO early payout.  Your final paycheck will be August 15th and your benefits will end August 31st 

OR 

Option 2 

______Receive final paycheck on June 30th.               (If you want to extend your benefits beyond June 30th, all premiums will be deducted from your final paycheck.) 

 

If you choose Option 2, you must also choose one of the following. 

______I choose to end my benefits on June 30th 

______I choose to end my benefits on July 31st 

______I choose to end my benefits on August 31st  

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Katy Independent School District

Human Resources Department

Exit Packet - Service Record Request Form (Please print clearly)

Employee Name: _______________________ Campus/Department:___________ KISD Employment Date(s): ______________________

Request Date: _______________ Resign Date: __________________

DOB: _______________ Last 4 SS #: __________________

Contact Phone #: ______________ Email address: __________________

*If you are resigning after the current school year completes, your record will be available approx. mid-July to late August depending on the volume of request.

*If you are resigning mid-year, your record will be available after your last pay check with the district.

Employee: (Official Record) Mailing Address:

_________________________________________

_________________________________________

_________________________________________

New School District: (Scanned to HR Contact) New School District Name: __________________________________ New District HR Contact: __________________________________ New District HR Email Address: __________________________________

Employee Signature: _____________________________________

Service Record Contact: 438 FM 1463 Katy, TX 77494 Phone #: 281-396-2347 TerriADomagas@Katyisd.org

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Employee Section

Human Resources Section

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