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KSRE Employee Resources

K-State Research and Extension - Local Unit Forms

Ext.Form File NameTitle & DescriptionUser Instructions
logos>Conflict of InterestDeclaration of Conflict of Interest and
Time Commitment Forms - KSU
Instructions
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Sabbatical Guidelines and

Application

Application and Guidelines for Sabbatical Leave
from Kansas State University
For Agents, approval of the Local Unit Board is also required for this application.

 
logos>publish

Making a Difference Template and

Making a Difference - SAMPLE

Making a Difference Template - Local Units
and SAMPLE

Instructions
PrintAdult Health FormVoluntary Adult Health Information Form 
 pdfMemorandum of UnderstandingMemorandum of Understanding 
 wordSuggested Agent Board ReportSuggested Agent Board Report
and Template
 
 pdfUniform Facsimile Signature Act  and FormUniform Facsimile Signature
of Public Officials Act
 
logos>pdfCR - 1Annual Civil Rights Update 
logos>pdfCR - 2Civil Rights Program Compliance
Review Guide 2020
 
logos>pdfCR - 3Demographics Data Collection Form 
logos>Printer Logo

EXOP3-2

Overtime Compensation Agreement for Non-Exempt EmployeesInstructions
logos>pdfEXOP3-5

Approval to Employ an Extension Program Assistant

Instructions
logos>Printer LogoEXOP3-9Screening of Office Professional and Program Assistant Applicants Prior to Interview
(Print Only)
Instructions
 logos>pdfEXOP3-11Employment Agreement
Office Professionals and Program Assistants
Instructions
pdfEXOP3-12

Orientation Checklist for Local Unit
Office Professionals and Program Assistants

Instructions
 logos>pdfEXOP3-13Employee Performance Review
Office Professionals and Program Assistants
Instructions
logos>pdfEXOP3-15Personnel Action Form
(For Regional Office Use Only)
Instructions
logos>pdfEXOP3-16Extension Agent Exit InterviewInstructions
logos>pdfEXOP3-17Employee Separation Checklist
for Local Unit
Instructions
logos>pdfEXOP3-18Exit Interview
Office Professional and Program Assistant
Instructions
logos>pdfFMLA1-1 to 1-4Family and Medical Leave Act
Overview (FMLA) & forms
Instructions
logos>pdfGAAP1-1 & 1-2.pdfGenerally Accepted Accounting Principles (GAAP) Waiver Resolution for Extension
  Local Unit Boards
Instructions

logos>pdf

KSU1-9c.pdfApplication for Study Leave
other than Sabbatical Leave
Instructions

logos>pdf

KSU1-10.pdf

Kansas Master Farm Family NominationInstructions

logos>pdf

KSU1-11.pdfPayment of Health Care Premiums for
State of Kansas Employees Health
Care Program for Non-State Groups
Instructions
logos>pdfKSU1-11b.pdfNotice of Intent to Participate in the State of
Kansas Health Care Program for
Non-State Groups
Instructions

logos>pdf

KSU1-12.pdfBank Draft Approval for State of Kansas
Employee Health Care Program
for Non-State Groups
Instructions

logos>pdf

KSU1-13.pdfExtramural Funds Approval Form 
logos>pdfKSU1-14.pdfElectronic Funds Transfer AuthorizationInstructions
logos>pdfKSU1-16.pdfArea Specialist Performance Appraisal
Input Form
Instructions
logos>pdfKSU1-18.pdfDirect Deposit of Salary AuthorizationInstructions
logos>pdf
KSU1-2a.pdf
Employees Agreement
(Counties with three or fewer Agents)
Instructions
logos>pdfKSU1-2b.pdfEmployees Agreement
(Counties with four more Agents and all Districts)
Instructions

logos>pdf

KSU1-2c.pdfLocal Unit EFNEP Agent AgreementInstructions

logos>Printer Logo

KSU4-1 - Financial Review Committee Responsibilities
for 4-H Club/Group and Other Extension
Affiliated Accounts
Instructions
Print onlyKSU4-24-H Club/Extension Group Financial
Review Checklist
Instructions
Print onlyKSU4-34-H Club/Extension Affiliated Group
Annual Financial Report
Instructions
Print onlyKSU4-44-H Club Treasurer Job DescriptionInstructions

logos>pdf

KSU8-1.pdfBudget for County
Extension Council
Instructions

logos>pdf

KSU8-2.pdfCertificate of Filing County
Extension Budget
Instructions

logos>Printer Logo

KSU8-3.pdfCertificate of Appropriation
(Print Only)
Instructions
logos>xlsKSU8-4a&b.xlsxExtension Council Executive Board Members
& County Extension Council Members
(Excel)
Instructions
ExcelKSU8-6, 8-7a, 8-7b & 8-9Financial Summary Forms for QuickBook UsersInstructions

logos>pdf

KSU8-10.pdfEquipment InventoryInstructions
logos>xlsKSU8-10.xlsEquipment Inventory
(Excel)
Instructions

logos>pdf

KSU8-15.pdfExtension Council
Member Record
Instructions
logos>xlsKSU8-15.xlsExtension Council Member Record - ExcelInstructions

logos>pdf

KSU8-17.pdfTravel Payment VoucherInstructions

logos>xls

KSU8-19.xlsCounty Financial Check Sheet with Budget
Development & Management Worksheets
(Excel)
Instructions

logos>pdf

KSU8-20.pdfOath to Support U.S. and
Kansas Constitution
(County Version)
Instructions

logos>pdf

KSU8-23.pdfPublic Notice of Annual Meeting of
County Extension Council
Instructions

logos>pdf

KSU8-24a.pdfPublic Notice of Extension Council
Election at Large
Instructions

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KSU8-24.pdfPublic Notice of Extension Council
Election at Three Locations
Instructions
logos>xlsKSU8-25.xlsRecord of Hours Worked & Leave for
Office Professionals (Excel)
Instructions
logos>Printer LogoKSU8-25.pdfRecord of Hours Worked & Leave for
Office Professionals (Print Only)
Instructions
logos>pdfKSU8-29OP.pdfOffice Professional
Application for Employment
Instructions
logos>pdfKSU8-29PA.pdfProgram Assistant
Application for Employment
Instructions
logos>pdfKSU8-30c.pdfOptional Annual Extension Agent Performance
Review:  External Feedback
Instructions
logos>pdfKSU8-32.pdfConsulting Request for Use by Extension AgentsInstructions

logos>pdf

KSU8-33.pdf

Crisis Management PlanningInstructions

logos>pdf

KSU8-33a.pdfCrisis Management Planning
(Pocket Form)
Instructions

logos>pdf

KSU8-34.pdfTransfer of Property and Funds
(From County Extension Councils
to Extension Districts)
Instructions
logos>pdfKSU8-35.pdfInvoiceInstructions
pdfKSU8-36.pdfPreferred Vehicle Log for Local UnitsInstructions
logos>xlsKSU8-37.xlsSalary Proposal WorksheetInstructions
pdfKSU8-38.pdfTemplate for Extension Board Meeting MinutesInstructions
logos>xlsKSU8-39.xlsxExtension Council/District Staff
Salary and Benefits Record
Instructions
PDFKSU8-40.pdfExcellence in Board Leadership
Board Assessment
 
logos>xlsKSU8-41.xlsProgram/Service Costs Calculation
Worksheets (On-Campus & Off-Campus)
Instructions
logos>xlsKSU8-42.xlsLocal Unit Employee Leave Monthly SummaryInstructions
ExcelKSU8-43.xlsProgram Staffing Plan Spreadsheet 
pdfKSU8-44 a & bChange Fund Authorization/Maintenance, Reconciliation of Change Fund and PolicyInstructions
pdfKSU8-45 a & bRaffle Application, Raffle Final Report, Sample and PolicyInstructions
pdfKSU8-47.pdfOrganizational Leadership and
Citizenship Summary
 
wordKSU8-48.wpdPerformance Review Narrative
(Word Document)
Instructions
pdfKSU8-49.pdfLocal Unit Extension Board/PDC Member Change FormInstructions
logos>xlsKSU8-50.xlsxAgent & Staff Benefit ProfileInstructions
logos>xlsKSU9-4.xlsxGoverning Board of the Extension District
(Excel)
Instructions
logos>pdfKSU9-6.pdfDistrict Office Space AgreementInstructions

logos>pdf

KSU9-10.pdfDistrict Equipment InventoryInstructions
logos>xlsKSU9-10.xlsDistrict Equipment Inventory
(Excel)
Instructions

logos>pdf

KSU9-15.pdfGoverning Body
Member Record
Instructions
logos>xlsKSU9-15.xlsGoverning Body Member Record - ExcelInstructions
logos>xlsKSU9-19.xlsDistrict Financial Check Sheet with
Budget Development & Management Worksheets
(Excel)
Instructions
logos>pdfKSU9-20.pdfOath to Support U.S. & Kansas Constitution
(District Version)
Instructions
logos>pdfPM1Handbook for County Extension
Councils & District Governing Bodies
Instructions
logos>Printer LogoPPM 6420.160 & 170Vehicle Daily Log for State UseInstructions
pdfPR-5 FY2022.pdfUnclassified Annual & Sick Leave
Record for FY 2022
Instructions
ExcelPR-5 FY2022.xlsUnclassified Annual & Sick Leave
Record for FY 2022
(Excel)
Instructions
For Classified Annual & Sick Leave Forms visit Division of Human Capital Services -
Forms Page  (Leave Record)

KSRE Business Office Forms - For Administration Use Only

pdfRecruit BudgetedRequest to Recruit for Faculty and Unclassified BUDGETED Position &/or New Position Number 
pdfRecruit Non-BudgetedRequest to Recruit for NON-BUDGETED Position &/or
New Position Number
 
Excel KSU1-17Recruiting/Offer Form  Instructions


For Information on Portable Document Format (pdf) files visit www.ksu.edu/tools/pdf webpage.

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