Student Health Prescreening Attestation

All students must conduct this health self-screen daily before entering the school

Do you currently have (or have had in the last 10 days) one or more of these new or worsening symptoms?

A temperature equal to or above 100 degrees F; Feel feverish or have chills; Cough; Loss of taste or smell; Fatigue/feeling of tiredness; Sore throat; Shortness of breath or trouble breathing; Nausea, vomiting or diarrhea; Muscle pain or body aches; Headaches; or Nasal congestion/runny nose.

In the past 10 days, have you tested positive for COVID-19 or have you been tested for COVID-19 and you are still waiting for the result?

In the last 10 days, have you been designated a contact of a person who tested positive for COVID-19 by a local health department?

In the last 14 days, have you traveled internationally to a CDC Level 2 or 3 COVID-19 related travel health notice country; or traveled to a state or territory on the New York State Travel Advisory List?

Further information on the list of states subject to the travel advisory can be found at

Student First Name

Student Last Name

Birthdate (mm/dd/yy)