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SCSS Covid-19 Reporting Form 2021-22

Student First Name*

Answer Required

Student Last Name*

Answer Required

Grade*

Answer Required

Covid-19 Test Details

Date when the symptoms started (if any)

(optional)

Answer Required

Date of Positive Test*

Date you got the result back

Answer Required

Date of Notification*

Date school was notified.

Answer Required

Time school was notified

Answer Required

Confirmation Email

Confirmation Email *

Email Required