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.


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Why are you completing this form? *
If your scholar tested positive, what date did they test positive?
年
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月
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日
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?
年
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月
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日
Scholar First Name *
Scholar Last Name *
Scholar's Birthday *
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月
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日
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?
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Google 表单