COVID-19 Positive Test Result Reporting Form

Please use this form to self-report your Covid-19 positive test result.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • example: Walgreens, CVS, Physicians Immediate Care Group
  • MM slash DD slash YYYY
  • Close Contact is defined as: Someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period* starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated. If not applicable indicate NA
  • Documentation of a Covid-19 Positive test is used to place a student on an Emergency Leave of Absence.
    Accepted file types: pdf, jpg, jpeg, png, gif, Max. file size: 128 MB.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Just wanted to say thank you! We took our children there for hair cuts today and our youngest had a very hard time. The staff and students were awesome and professional through the whole process! Thank you so much for understanding and the clear culture of patience and acceptance you foster! Russell E., Client.