Self Reporting Travel Form
Students, Staff and Parents are asked to complete this form in order for The District to keep an accurate report on active or potential Coronavirus cases. Please report any international travel (personal or professional) to Level 1 or higher risk countries (as of 3/9/20, this includes China, Iran, South Korea, Italy, Japan and Hong Kong).
Full Name (First, Last)
I am a_______?
Primary Phone Number
Please Select Travel Type
I have recently traveled within the last 45 days
I plan to travel within the next 45 days
I do not have plans to travel within the next 45 days
Never submit passwords through Google Forms.
This form was created inside of Rhodes School.