Add Your School to the Map
Complete the form and our admin will update the map within 5 business days.
Sign in to Google to save your progress. Learn more
School Name *
Street Address *
City *
County *
Year Opened
Medical Sponsor Organization
Sponsor Contact Name
Sponsor Contact Email
Website
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pennsylvania School Based Health Alliance.

Does this form look suspicious? Report