2022-2023 Laureate COVID-19 Reporting Form

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ATTENTION: If you are submitting this form because your scholar has tested positive for COVID-19 please DO NOT send your scholar to school.

Please email your scholar's teacher(s) directly to coordinate getting their makeup work.

Why are you completing this form? *

My scholar tested positive for COVID-19

Other:

If your scholar tested positive, what date did they test positive?

YYYY

What type of test did your scholar receive? *

Rapid

PCR

Unknown

They did not take a test

Other:

Does your scholar have symptoms of COVID-19? *

Yes

Other:

Scholar First Name *

Scholar Last Name *

Grade Level *

Scholar's Birthday *

YYYY

Parent First & Last Name *

Parent Phone Number *

Parent Email Address *

How is the "parent" related to the scholar? *

Mother

Father

Grandparent

Other:

Scholars Gender *

Male

Female

Other:

Ethnicity *

Hispanic

Non-Hispanic

Other:

Race *

Black

White

Asian

American Indian/Alaska Native

Native Hawaiian/Other Pacific Islander

Other:

How many doses of the vaccine has your scholar received? (This helps us calculate quarantine days) *

2 & the booster

I'd rather not answer

Other:

Does the scholar have access to a laptop at home for virtual school work? *

Yes

Other:

Does the scholar have access to internet at home for virtual school work? *

Yes

Other:

What other information should the school know?

Submit

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