STEM Academy Daily Attendance & Health Screening Form
This form must be completed prior to arriving to the STEM Academy/CVCC site. The screening items come from the Virginia Department of Health and CDC guidance.

Please read each item carefully and thoughtfully, then select either "Yes" or "No" for each item.

After answering the screening items, select if you plan to report to the STEM Academy. This will help us with our attendance records as daily attendance is reported to each base school.
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Email *
Please type in your First and Last Name *
Select YES or NO for each of the follow: I have had... *
Yes
No
A fever (38.0°C or 100.4° F or higher) or a sense of having a fever?
A new cough that cannot be attributed to another health condition?
New shortness of breath or difficulty breathing that cannot be attributed to another health condition?
New chills that cannot be attributed to another health condition?
A new sore throat that cannot be attributed to another health condition?
New muscle aches (myalgia) that cannot be attributed to another health condition or specific activity (such as physical exercise)?
A new loss of taste or smell?
Contact with someone in the past 14 days with suspected or confirmed COVID-19?
A positive COVID-19 test result myself from which I have not yet been medically cleared.?
Please select one of the following options, and thank you for completing your at-home health screening. By working together, we can minimize our health risks! *
If you selected that you will not report to STEM Classes in person above will you be attending classes via Zoom?
Clear selection
If you will be attending classes via Zoom due to a teacher illness or exposure please indicate below
Clear selection
If you have any questions or concerns about this form, please type them in the box below. Thank you!
A copy of your responses will be emailed to the address you provided.
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