Student is a close contact to a positive COVID-19 case
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Email *
Email *
Student's First Name *
Student's Last Name *
Student's Grade *
Homeroom Teacher *
Name of person completing the survey. *
Relationship to student is *
Close contact occurred at *
Date of last contact with positive case. *
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Do you have symptoms? *
What date did symptoms start?  If no symptoms, please use the date of last contact. *
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Please use the above date for the next two questions.
What is day 6 of quarantine?
Please use previous date as day 0 and add 6 days.
Day 6 date. *
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DD
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YYYY
What is day 11 of quarantine?
Please use previous date as day 0 and add 11 days.
Day 11 date. *
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YYYY
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