if your status has changed multiple times, please submit this form once per each status change, setting the effective date to the date when that change took effect. District Name or ID Use this field to search for your district by name or agency id.Selected District* Effective Date*Select the date when you began using this mode of operations. MM slash DD slash YYYY Elementary School Classroom Mode*Select the option that most closely describes how your ELEMENTARY SCHOOL classrooms are operating. Remote Learning In School Split School and Remote Middle School Classroom Mode*Select the option that most closely describes how your MIDDLE SCHOOL classrooms are operating. Remote Learning In School Split School and Remote High School Classroom Mode*Select the option that most closely describes how your HIGH SCHOOL classrooms are operating. Remote Learning In School Split School and Remote Learn more about these classifications In School - School is intended to be fully in-school learning. Includes when some students may need to be on remote learning due to self-isolation after exposure to a communicable disease. Remote Learning - Includes when all or nearly all students are in remote learning. Some students, such as certain SPED students, may still be provided services at school. Split School and Remote - Includes where some students are in school and some students are in remote learning, in order to provide for social distancing, enhanced cleaning and disinfecting of school facilities, etc. This could include all students in school some days of the week and all students in remote learning other days; half of the students in school and half remote; or other configurations. Students Using Remote OptionsWere families/caregivers able to select a fully remote option for ELEMENTARY students?* No Yes How many ELEMENTARY students currently are using the remote learning option?* Numeric Values OnlyWere families/caregivers able to select a fully remote option for MIDDLE SCHOOL students?* No Yes How many MIDDLE SCHOOL students currently are using the remote learning option?* Numeric Values OnlyWere families/caregivers able to select a fully remote option for HIGH SCHOOL students?* No Yes How many HIGH SCHOOL students currently are using the remote learning option?* Numeric Values OnlyDescribe the Split School and Remote format.*Additional InformationUse this field to provide any additional information, including the learning model for students who are required to self-isolate due to potential exposure to COVID.NameThis field is for validation purposes and should be left unchanged. 02-6159
