CT – Blue Form Survey

District/Town(s) or City *

School Medical Advisor Name *

First

Last

If none, type N/A

Preferred Contact Person *

First

Last

Preferred Contact Person Email *

Preferred Contact Phone

2020-2021 School Year Blue Form Policy Info *

When are the forms due? Are extensions granted? How long ago can a WCC be done and still ‘count’? Please add all information pertinent.

Any other district info to share? *

Please include or type N/A if there is none.

Link to school reopening plan/policy, if available.