COVID-19 Staff/Family Reporting - Epic Charter Schools

COVID-19 Reporting Form

This form is used to comply with the Oklahoma State Department of Education's effort to track COVID-19 exposures as well as those who test positive for the virus. Data submitted here will be kept confidential.

I am *

a parent of an Epic student.

a student at Epic.

a staff member at Epic.

Your Name *

Please submit your first and last name.

Email *

Please enter your email address.

Student's Name *

If reporting more than one student in your home, we ask that you complete a separate form for each student. (NOTE: If the student you are reporting is 18 years of age or older, the student must complete the form on their own.)

Student ID *

This is the same series of initials and numbers as the login for your curriculum.

Type of report *

Please select one of the following.

I have been in close contact with someone who tested positive for COVID.

I have tested positive for COVID.

Type of Report *

Please select one of the following.

This student has been been in close contact with someone who tested positive for COVID.

This student has tested positive for COVID-19.

Date of Onset of Symptoms *

Date of Positive Test Result *

Date of Positive Test Result of Person with Whom You Had Contact *

I work: *

Remote

In-Office

at a VLC

In-Office Location

50 Penn

Grace

Tulsa

Waterloo

VLC Location *

Stonegate Learning Center

Tulsa Elementary Learning Center

Tulsa MidHigh School Learning Center