Student Absence Form Question Title * 1. Please type your first and last name in the box below. Question Title * 2. Why are you absent from school? I don't feel well Personal demands Had an appointment I had to work I tested positive for Covid ---> Go straight to question 4 Other Question Title * 3. Did you get a positive result on a Covid test?(If YES, isolate for 5 days, with day zero being the first day of symptoms or the positive test) Yes No Question Title * 4. Are you experiencing any Covid symptoms?(If YES, isolate for 5 days, with day zero being the first day of symptoms or the positive test) Yes No Question Title * 5. What date did you test positive or begin experiencing symptoms? Date / Time Date Question Title * 6. What date do you anticipate coming back to class? Date / Time Date Question Title * 7. Do you have any questions, or concerns? No Question or Concern (please specify): Question Title * 8. Would you like me to contact you? No Yes.Include the phone number or email address you would like me to contact you at. Done