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PCS Request for Remote Conferencing
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* Indicates required question
Email
*
Your email
First Name
Your answer
Last Name
Your answer
Person who is experiencing COVID-19 symptoms or has a positive test or exposure
Student
Someone Else
Other:
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Student is enrolled in which campus
Temple Charter Academy
Cove Charter Academy
Georgetown Charter Academy
Cedar Park Charter Academy
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Student Grade Level
Pre-Kindergarten
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Eighth
9th
10th
11th
12th
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Last day attended
MM
/
DD
/
YYYY
What was the date of the first COVID-19 symptom for your student?
MM
/
DD
/
YYYY
What was the date of the most recent COVID-19 test for your student?
MM
/
DD
/
YYYY
Has the student received a lab-confirmed positive COVID-19 test recently?
Yes
No
Clear selection
First day absent
MM
/
DD
/
YYYY
Is the student planning on participating in Remote Conferencing?
Yes
No
Clear selection
Parents name
Your answer
Parents Phone number
Your answer
Parents email
Your answer
Submit
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