COVID-19 Exposure/Symptoms Contact Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

COVID-19 Exposure/Symptoms Contact Form

Complete the form below if you are experiencing COVID-19 symptoms or you have been exposed to a person that has COVID-19. In order to know the next steps for you, please make sure you read the information closely and respond truthfully.

Sign in to Google to save your progress. Learn more

* Indicates required question

Email *

Your email

Option 1

Clear selection

Merancas Student First Name *

Your answer

Merancas Student Last Name *

Your answer

Parent/Guardian Phone Number *

Your answer

Merancas Student Phone Number *

Your answer

Next

Clear form

Never submit passwords through Google Forms.

This form was created inside of Charlotte Mecklenburg Schools. Report Abuse