MI Backpack Home Test Program - COVID At-Home Antigen Test Kit Request Form
Please use this form to request Backpack home test kits.

MI Backpack Home Test Program - An At-Home COVID-19 Testing Program for K-12 Settings

The Michigan Department of Health and Human Services (MDHHS) is offering a new program to make a limited number of free, at-home COVID antigen tests available to students in Michigan's schools in the 2021-2022 school year. MI Backpack Home Tests is a voluntary program offered by MDHHS for Michigan K-12 students, educators, staff, and their families who want an extra layer of protection against COVID-19. Every person enrolled in the program will receive one at-home COVID-19 test "kit," which includes 2 at-home tests. MDHHS will provide the kits and educational materials, and schools will distribute the kits to students and staff who choose to enroll. There is no obligation to participate.  This pilot program offers one more tool-in addition to in-school testing, masking, ventilation, and other strategies-to create a safer environment for students, staff, and families.

For more information about the MI Backpack Home Test Program, please go to https://www.michigan.gov/documents/coronavirus/At_Home_Testing_-_Public_Guidance_09142021_735381_7.pdf.
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Email *
How many At-Home COVID-19 antigen test kits are you requesting? *
You may request as many test kits as the number of active children you currently have attending Coldwater Community Schools.  Each test kit contains two antigen tests.
Please use this form to request an At-Home COVID-19 antigen test kit.
Parent/Guardian Name *
Student name 1 *
Please select the grade level of the student listed above. *
Student 1
Student name 2
Leave blank if not applicable
Please select the grade level of the student listed above.
Student 2 - Leave blank if not applicable
Student name 3
Leave blank if not applicable
Please select the grade level of the student listed above.
Student 3 - Leave blank if not applicable
Student name 4
Leave blank if not applicable
Please select the grade level of the student listed above.
Student 4 - Leave blank if not applicable
Student name 5
Leave blank if not applicable
Please select the grade level of the student listed above.
Student 5 - Leave blank if not applicable
Student name 6
Leave blank if not applicable
Please select the grade level of the student listed above.
Student 6 - Leave blank if not applicable
Home address *
Parent/guardian email address *
By submitting this form, I certify that I am the parent/guardian of the student(s) listed above and I would like my child(ren) to participate in the MI Backpack Home Test Program.
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