* 1. School Name

* 2. School Address

* 3. School Telephone Number

* 4. Name of School Principal/Director

* 5. Name of Person Completing this Survey

* 6. What kind of TB risk school are you reporting for?

* 7. Email address of person completing report:

Your email address will be used to send a confirmation of receipt of your report. Confirmation emails will be sent weekly; they will not contain a copy of your answers.