COVID-19 Student Travel Report Form
Use this form to report student and parent travel to level 3 designated countries - Currently: China, Iran, Italy and South Korea (This list is subject to change)
Email address *
Student's first and last name: *
Best contact number for student/family: *
Which Level 3-1 country did the student visit? *
Date that student returned from level 3 designated country: *
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Date that student may return to school and is symptom-free (must be no less than 14 days from return date to US):
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School that the student attends: *
Student's grade level: *
Does your student have access to technology in their home (i.e. desktop, laptop, chromebook, iPad)? *
Does your student have access to the internet in their home? *
A copy of your responses will be emailed to the address you provided.
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