When reporting a positive COVID-19 case, please complete all areas of the form. A CDSD employee will contact you to confirm receipt of the completed form.
Student's First and Last Name
Guardian's First and Last Name
Guardian's Phone Number
School Student Attends
Central Dauphin East High School
Central Dauphin High School
Central Dauphin East Middle School
Central Dauphin Middle School
Swatara Middle School
Linglestown Middle School
Chambers Hill Elementary School
Lawnton Elementary School
Linglestown Elementary School
Middle Paxton Elementary School
Mountain View Elementary School
North Side Elementary School
Paxtang Elementary School
Paxtonia Elementary School
E.H. Phillips Elementary School
Rutherford Elementary School
South Side Elementary School
Tri-Community Elementary School
West Hanover Elementary School
Date of Positive COVID-19 Result
Is the student
Symptomatic (Experiencing Symptoms)
Asymptomatic (Not Experiencing Symptoms)
If symptomatic, on what date did symptoms begin?
Does the student participate in CDSD extra-curricular activities that are currently meeting in-person?
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Central Dauphin School District.