District 196 Athletics/Activities Event Worker Form - Apple Valley High School
This form collects information on individuals who provide services to District 196 in order to process payment for the service. The information collected will be used and maintained within the district by staff responsible for overseeing the services provided and/or staff responsible for ensuring proper payment. It may also be shared as permitted by state and federal law, including federal and state tax law. You are required to provide the requested information in order to receive payment.

Please complete the form in its entirety and as thoroughly as possible. Inaccurate and/or incomplete information on this form may delay processing by the Accounts Payable or the Payroll Departments. If you have questions regarding the form, please reach out to the Activities Office of the host school.

Note: Each school within District 196 has its own unique form. Workers must complete the form specific to that school for an event for payment to be processed correctly and timely.
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By entering your name in the space below, you are (1) electronically signing this form and agreeing that this signature shall have the same legal validity as a handwritten signature; (2) acknowledging you have read and understand the form’s disclosures relating to why and how your information is being collected and maintained; and (3) attesting that the information supplied on this form is true and complete.
Last Name *
Your answer
First Name *
Your answer
Middle Initial
Your answer
Today's Date *
MM
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DD
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YYYY
Email Address *
A copy of the submitted voucher to the Finance Office will be emailed to you upon completion by the host school athletic department.
Your answer
Please specify your employment status with ISD 196 *
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