Laureate: COVID-19 Reporting & Contact Tracing Form (COVID-19 & Close Contact Exposure)
ATTENTION: If you are submitting this form because your scholar has tested positive for COVID-19 or they have been identified as a close exposure please DO NOT send your scholar to school.

Someone will be in touch within 1 business day to give you more information on next steps.


Sign in to Google to save your progress. Learn more
Why are you completing this form? *
If your scholar tested positive, what date did they test positive?
MM
/
DD
/
YYYY
What type of test did your scholar receive? *
Does your scholar have symptoms of COVID-19? *
If your scholar had a close contact exposure to someone who has tested positive for COVID-19, what date was the exposure?
MM
/
DD
/
YYYY
Scholar First Name *
Scholar Last Name *
Scholar's Birthday *
MM
/
DD
/
YYYY
Parent First & Last Name *
Parent Phone Number *
Parent Email Address *
How is the "parent" related to the scholar? *
Grade Level *
Homeroom Teacher's Last Name *
Scholar's Age *
Scholars Gender *
Ethnicity *
Race *
How many doses of the vaccine has your scholar received? (This helps us calculate quarantine days) *
Does the scholar have access to a laptop at home for virtual school work? *
Does the scholar have access to internet at home for virtual school work? *
What other information should the school know?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Laureate Academy Charter School. Report Abuse