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International Travel Notification Form
Mustang Public Schools - STAFF
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* Indicates required question
Name(s) of those travelling (First, Last):
*
Your answer
Building/Site Where You Work:
*
Your answer
Contact Information
Phone
*
Your answer
Email
Your answer
Please identify an emergency contact (Name, Relationship, Phone):
Your answer
Travel Information
Are you planning on traveling or are you currently traveling outside the United States?
*
Yes
No
Where are you currently traveling or planning to travel? If other, please specify the location outside the United States.
*
Mainland China
Iran
Italy
South Korea
Japan
Other:
Please describe your travel plans. Include U.S. departure and U.S. arrival dates and locations visited (city/country).
*
Your answer
Are you aware that you must self-quarantine for 14 days prior to returning to school if you have traveled to China, Iran, Italy, South Korea, Japan or any other country determined to be a Level 2 or Level 3 by the CDC (
https://wwwnc.cdc.gov/travel/notices
)?
*
Yes
No
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