For Site Coordinators

Site Coordinator Forms

PCCUA Employment Forms:

  1. Part-time Employment Form
  2. PCCUA Employment Application
  3. Arkansas Withholdings Form
  4. W-4
  5. I-9
  6. Direct Deposit Form 
  7. Healthcare Receipt (MUST BE RETURNED TO GEAR UP OFFICE)

In addition to the forms listed above, completed employment packets should include:

  1. Copy of the employee’s driver’s license or acceptable ID card
  2. Copy of the employee’s Social Security Card
  3. A voided check, if the employee is enrolling in direct deposit

Prior to submitting New Hire Paperwork, verify that all of the documents are COMPLETE and SIGNED by the employee.

Reporting Forms:

  1. Cost Share Contribution Form (for Teachers or Staff)
  2. In-Kind Match Form (for all others)
  3. Monthly Attendance and Discipline Form
  4. Monthly Service Report (for the school district)
  5. Staff Activity Log (to be returned with timesheets)
  6. GEAR UP Team Designation Form
  7. GEAR UP Year 3 Report (By Grade)