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COVID-19 Student Travel Report Form
Use this form to report student and parent travel to level 3 designated countries - Currently: China, Iran, Italy and South Korea (This list is subject to change)
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* Indicates required question
Email
*
Your email
Student's first and last name:
*
Your answer
Best contact number for student/family:
*
Your answer
Which Level 3-1 country did the student visit?
*
China - Level 3
Iran - Level 3
Italy - Level 3
South Korea - Level 3
Japan - Level 2
Hong Kong - Level 2
Other:
Date that student returned from level 3 designated country:
*
MM
/
DD
/
YYYY
Date that student may return to school and is symptom-free (must be no less than 14 days from return date to US):
MM
/
DD
/
YYYY
School that the student attends:
*
Your answer
Student's grade level:
*
Your answer
Does your student have access to technology in their home (i.e. desktop, laptop, chromebook, iPad)?
*
Yes
No
Other:
Does your student have access to the internet in their home?
*
Yes
No
Other:
A copy of your responses will be emailed to the address you provided.
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