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COVID-19 School Reporting
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* Indicates required question
Email
*
Your email
I am a
*
student
staff member
Last Name, First Name
*
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Grade Level
*
Choose
N/A - I am a Warren Employee
Pre-K
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Campus
*
Choose
Fred
WES
WJH
WHS
Maintenance
Transportation
Cafeteria Staff
Custodial Staff
Cell Phone Number ex: 409-555-1212
*
Your answer
Parent/Guardian - first name, last name
*
Your answer
Parent/Guardian - in "other" type first name, last name
*
N/A - Warren Employee
Other:
Your position at WISD
*
Choose
Student
Teacher
Adminstrator
Paraprofessional
Coach
Bus Driver
Transportation
Cafeteria Staff
Custodial Staff
Other Staff Member
Car Rider/Bus Rider
*
Choose
N/A - Staff Member
Car Rider
Bus Rider
Extracurricular Activities
*
Choose
Not Applicable
Band
Choir
Theater
Baseball
Football
Softball
Track and Field
Golf
Soccer
Tennis
Cheer
Drill Team
Swimming
Other UIL Activity
If more than one activity, list additional activities here
Your answer
Vaccination Status
*
Choose
Vaccinated
Unvaccinated
Cannot be vaccinated
One Dose
Prefer not to answer
Test Type
*
Choose
Rapid Test
PCR - Test that is sent to lab for processing and is not rapid in nature
Date of Onset of Symptoms
*
MM
/
DD
/
YYYY
Last day on Campus
*
MM
/
DD
/
YYYY
Date of COVID Test
*
MM
/
DD
/
YYYY
Testing Facility
*
Warren ISD Nurse's Office
Other:
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