Covid-19 Self-Test Form

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Covid-19 Self-Test Form

Please fill out the form below after receiving the results from your self-test kit.
The information collected is for Administration only.

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* Required

Date *

MM

/

DD

/

YYYY

NAME (Last name, First name) *

Your answer

Self-test results? *

Positive

Negative

Void

Required

Your role at B.I.? *

Choose

Student

Faculty/Teacher

Staff

Pastor

Board Member

Grade Level ? *

Choose

None

Pre-K

K

1

2

3

4

5

6

7

8

9

10

11

12

All Grades

Only High School

Only Elementary

Only Middle School

Middle and High School

Submit

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