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Student Covid reporting Academy HS-22-23
Student Covid reporting Academy HS-22-23
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* Indicates required question
Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student ID #
*
Your answer
Grade Level
*
9th
10th
11th
12th
Reason for report
*
Student tested positive for Covid
Date Tested
*
MM
/
DD
/
YYYY
Test Type
*
PCR
Antigen
Home Test
Unknown
Date Symptoms began
*
MM
/
DD
/
YYYY
Report submitted by Parent/Guardian Name
*
Your answer
Parent Contact Phone Number
*
Your answer
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