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COVID-19 Case Reporting Document

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  Date REQUIRED Please fill out this field. Please enter a date.
  
  Name of School REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Person Submitting This Form REQUIRED Please fill out this field. Please enter valid data.
  
  Affiliation with School of COVID-19 Individual REQUIRED Please fill out this field.
  
  Other Details: REQUIRED Please fill out this field.
  
  Name of Local Health Department Where COVID-19 Positive Individual’s Information Was Sent: REQUIRED Please fill out this field. Please enter valid data.
  
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