COVID-19 Student Self Reporting Form

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Please complete this form if your student has tested positive for COVID-19 OR has been in close contact with someone that has test positive for COVID-19. Providing this information to the district will assist us in creating accurate contact-tracing reporting.

Parent First and Last Name *

Parent Email Address *

Student First and Last Name *

Student Date of Birth *

YYYY

Campus *

Humble

Northshore

Grade Level *

Pre-Kindergarten

Kindergarten

First

Second

Third

Fourth

Fifth

Sixth

Seventh

Eighth

Please select the following option that is most accurate. *

My student has tested positive for COVID-19.

My student has recently been in close contact with someone who tested positive for COVID-19.

I am experiencing two or more COVID-19 symptoms.

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