Application for AC/EC Credits for COVID-Related Absences

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

This form is for the request for AC/EC tuition credits for absences related to COVID due to infection or exposure. This form must be submitted IN ADDITION TO notifying the school health office of the absence and must be filled out NO MORE THAN FIVE DAYS after the positive test or notification of exposure. Please note that filling out this form does not guarantee that you will receive the credits. A separate form must be filled out for each student.

Email *

1. AC/EC Student's Name *

2. AC/EC Student's Home School *

3. Reason *

My AC/EC student has tested positive for COVID (skip to question 9)

My AC/EC student has a household member that has tested positive for COVID (continue to question 4)

My AC/EC student has been deemed a close contact of a non-household member who has tested positive for COVID (skip to question 6)

Household Contacts

Please answer questions 4 & 5 ONLY if your AC/EC student has a household member who has tested positive for COVID.

4. Is isolation from the infected person possible?

Yes (skip to question 9)

No (continue to question 5)

Clear selection

5. Has the AC/EC student been vaccinated?

Yes (skip to question 9. Your child does not need to quarantine unless they are symptomatic)

No (skip to question 9)

Clear selection

Non-Household Contacts

Please answer questions 6 & 7 ONLY if your child has been deemed a close contact to a non-household member who has tested positive for COVID.

6. Has the AC/EC student been vaccinated?

Yes (skip to question 9. Your child does not need to quarantine unless they are symptomatic)

No (continue to question 7)

Clear selection

7. Has the AC/EC student become symptomatic?

Yes (continue to question 9)

No (continue to question 9)

Clear selection

Classroom Shutdown

Please answer question #8 ONLY if your child's ISD 622 classroom has been shut down due to a high number of COVID cases.

8. What is your child's teacher's name?

9. IMPORTANT INFORMATION

We will review your responses and work with Health Services to determine the length of quarantine and whether credits will be provided. Any credits received will post to a later invoice. Please continue to pay all invoices on time to avoid receiving late fees.

Any COVID-related absences must be provided to the school health office as soon as possible.

This form must be filled out within five days of the positive test (child or household contact) OR notification of close-contact exposure (non-household contact) and all questions pertaining to the appropriate type of quarantine must be answered.

Credits will not be given for symptomatic students or household members without a positive test, nor will credits be given for testing.

This form does not guarantee a credit will be issued.

Credits received will be for the minimum amount of time a child is required to be out. Should you choose to keep your child out for their full quarantine rather than having them tested and applying for a reduced quarantine, you will not receive credit for those extra days. To learn more about the minimum lengths of quarantines, please contact your child's school health office.

You must fill out a separate form for each AC/EC child for whom you are requesting credits.

I have read and understand all of the above information. Please type your name below. *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of ISD 622. Report Abuse

Forms