Student Positive Self-Report
Use this form if you are a parent or student enrolled in Jeffco Public Schools. If you are a student under 18 years of age, this form requires the approval of a parent/guardian to submit. Participation will help the district track incidence of COVID-19 during periods of remote learning. You may also directly contact your school nurse.
* Required
Student ID
Your answer
Student First Name
*
Your answer
Student Last Name
*
Your answer
Parent/Guardian Full Name
Your answer
Parent/Guardian Preferred Contact Telephone Number
Your answer
Parent/Guardian Preferred Email
Your answer
In which school is your student currently enrolled?
*
If the student is enrolled in more than one school please select the students primary school of enrollment.
Adams Elementary
Addenbrooke Classical Academy
Addenbrooke Classical Grammar School
Alameda International Junior/Senior High School
Allendale Elementary
Arvada High
Arvada K-8
Arvada West High
Bear Creek High
Bear Creek K-8
Bell Middle
Belmar School of Integrated Arts
Bergen Meadow Elementary
Bergen Valley Elementary
Blue Heron Elementary
Bradford K8 North
Bradford K8 South
Brady Exploration
Campbell Elementary
Carmody Middle
Chatfield High
Coal Creek Canyon K-8
Collegiate Academy
Colorow Elementary
Columbine High
Columbine Hills Elementary
Compass Montessori Golden
Compass Montessori Wheat Ridge
Conifer High
Connections Learning Center
Coronado Elementary
Creighton Middle
Dakota Ridge High
Deane Elementary
Deer Creek Middle
Dennison Elementary
D'Evelyn Junior/Senior
Devinny Elementary
Doral Academy of Colorado
Drake Middle
Dunstan Middle
Dutch Creek Elementary
Edgewater Elementary
Eiber Elementary
Elk Creek Elementary
Emory Elementary
Evergreen High
Evergreen Middle
Everitt Middle
Excel Academy
Fairmount Elementary
Falcon Bluffs Middle
Fitzmorris Elementary
Fletcher Miller Special
Foothills Elementary
Foster Dual Language PK-8
Free Horizon Montessori
Fremont Elementary
Glennon Heights Elementary
Golden High
Governor's Ranch Elementary
Great Work Montessori
Green Gables Elementary
Green Mountain Elementary
Green Mountain High
Hackberry Hill Elementary
Hutchinson Elementary
Irwin Preschool
Jeffco Open School
Jeffco Virtual Academy
Jefferson Academy
Jefferson Academy Elementary
Jefferson Academy High School
Jefferson County Open Elementary School
Jefferson High
John & Karen Litz Preschool
Ken Caryl Middle
Kendallvue Elementary
Kendrick Lakes Elementary
Kullerstrand Elementary
Kyffin Elementary
Lakewood High
Lasley Elementary
Lawrence Elementary
Leawood Elementary
Lincoln Academy
Little Elementary
Long View
Lukas Elementary
Lumberg Elementary
Mandalay Middle
Manning School of Academics and Arts
Maple Grove Elementary
Marshdale Elementary
Mc Lain Community High School
Meiklejohn Elementary
Mitchell Elementary
Molholm Elementary
Montessori Peaks Academy
Moore Middle
Mortensen Elementary
Mountain Phoenix Community School
Mountview Youth Service Center
Mt. Carbon Elementary
New America
Norma Anderson PK
Normandy Elementary
North Arvada Middle
Oberon Middle
Parmalee Elementary
Parr Elementary
Patterson Elementary
Peak Expeditionary at Pennington
Peck Elementary
Peiffer Elementary
Pomona High
Powderhorn Elementary
Prospect Valley Elementary
Ralston Elementary
Ralston Valley High
Red Rocks Elementary
Rocky Mountain Academy of Evergreen
Rocky Mountain Deaf
Rooney Ranch Elementary
Rose Stein International Elementary
Ryan Elementary
Secrest Elementary
Semper Elementary
Shaffer Elementary
Shelton Elementary
Sheridan Green Elementary
Sierra Elementary
Slater Elementary
Sobesky Academy
South Lakewood Elementary
Standley Lake High
Stevens Elementary
Stober Elementary
Stony Creek Elementary
Stott Elementary
Summit Ridge Middle
Swanson Elementary
Thomson Elementary
Three Creeks K-8
Two Roads Charter School
Ute Meadows Elementary
Van Arsdale Elementary
Vanderhoof Elementary
Vivian Elementary
Warder Elementary
Warren Tech
Warren Tech North Campus
Wayne Carle Middle
Weber Elementary
Welchester Elementary
West Jefferson Elementary
West Jefferson Middle
West Woods Elementary
Westgate Elementary
Westridge Elementary
Wheat Ridge High
Wilmore-Davis Elementary
Wilmot Elementary
Witt Elementary
Woodrow Wilson Academy
Other:
Students Current Grade Level
*
PK
KG
1
2
3
4
5
6
7
8
9
10
11
12
Other:
Student Test Date
*
MM
/
DD
/
YYYY
Date you Received Students Test Results
*
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of Jefferson County Public Schools.
Report Abuse
Forms