COVID Screening
Please answer the following questions regarding your experience during the COVID pandemic. Please complete this (or help your child complete it) and submit as soon as possible, BEFORE the first day of school.  Your responses will help us to identify students who may be in need of additional support as we begin learning together.  Your responses are confidential and will only be viewed by the district mental health staff members as we work to support students in our Return to Learn plan.
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Which school do you attend? *
Grade this year *
For the first marking period, I am attending: *
Last Name *
First Name *
1. Have you or someone close to you gotten very sick or been in the hospital because of this illness? *
2. Have you or someone close to you been quarantined because of having symptoms of this illness? *
3. Have you or someone close to you been told of a positive test for this illness? *
4. Does someone close to you work around people who might have this illness? *
5. Have you or a family member had to move away from home because of this illness? *
6. Has anyone close to you died because of this illness? *
If yes, can you tell me who?
7. Has a military member of your family been deployed to a place where people have this illness? *
8. Has anything else happened to you/your family because of this illness that has been very upsetting?
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