Forms

Pleasantville Elementary
300 W. Columbus Street
Pleasantville, OH 43148
Phone: 740-468-2181
Fax: 740-468-3539

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Each form is listed twice. The first is in PDF format. The second is an RTF file which is required for compliance with the Americans with Disabilities Act.

Pleasantville Elementary Forms

Archived News

2024-2025 Income & S-EBT Survey

All enrolled students of Fairfield Union Local Schools are eligible to receive a healthy breakfast and lunch at school at no charge to your household each day of the 2024-2025 school year. No further action is required of you. Your child(ren) will be able to participate in these meal programs without having to pay a fee or submit an Income & S-EBT Survey (formerly called the Free and Reduced Meal Application). However, to secure Federal Title funds for educational programs across the District, it is critical for the District to collect as many Income & S-EBT Surveys as possible.

We are asking all parents to complete theIncome & S-EBT Survey that is available in your PaySchools account. The direct link to the PaySchools (lunch account) system is: PaySchools Central LogIn Page.

We appreciate your willingness to complete the Income & S-EBT Survey through PaySchools. However, if you would prefer to complete a hard copy of the application, please download the application from this link: Income & S-EBT Survey or contact your child(ren)’s school for a copy of the application. For questions regarding eligibility, parents can refer to this document: Income Eligibility Guidelines

Additional questions regarding our Food Service program should be directed to the Food Service Director, Diana Browning, at the District Office. You can also email Mrs. Browning at [email protected].

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Forms

ADA Disclaimer

Pleasantville Elementary Forms

2024-2025 Income & S-EBT Survey

Dispensing Medication Forms

Ohio School Health Physicians Report

Student Accident Insurance Plans 2023-2024

Open Enrollment Application