Student COVID Data Reporting Form
If you are reporting more than one student, please fill out one form per student. Thank you!

This form was updated on 1/22/21.
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Student First Name *
Student Last Name *
Student ID *
Your Name *
Please record your first and last name.
I am reporting a case of COVID-19 or quarantine as a *
Your Email Address *
Your Phone Number
Student's Current Status *
A positive case is defined by a first-hand account of a person who has received a positive test that has been conducted by a medical expert. Close contact exposure is when the two people are within 6 feet of each other for more than 15 minutes.
Date tested, if applicable
If tested, the result was
Clear selection
Current Symptoms *
Check all that apply
Parent / Guardian Names
Date of Symptom(s) Onset
If the student has symptoms, please indicate the day symptoms began.
Date of Exposure
Enter the last day the student was exposed to someone who was COVID positive.
Where was the student most likely exposed? *
Building *
Grade Level *
Please list the names of siblings or other Mason students living in the home.
Is your child learning in-person or online? *
Is the student currently in option 1 (in-person) or option 2 (online)?
Current Extra-Curricular Activities
Please include any and all of the student's extra curricular activities that you are aware of at this time - teams, clubs, groups, etc.
Additional Notes
If there are additional details you feel are important, please do so here.
The student
Does the student intend to participate in remote learning while at home? *
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