School Pre-Closure Form - H1N1 Flu

The following form is to be filled out when a district or individual campus(es) are closing because of H1N1 flu. Data from this form will be used to keep the public informed – via the TEA website H1N1 Known School Closings -- about school closures, the number of students and staff affected, and actual closure dates.

The first section has several “Required” fields that must be filled in before submitting the form. The second section, titled “Optional,” is for districts with individual campuses closing – NOT the entire district.

If you need to clear the form and start over, there is a “Reset” button at the bottom.

If you have any questions, please contact Mike Peebles at the Texas Education Agency: Mike.Peebles@tea.state.tx.us or 512-463-5917.

REQUIRED

Your Email Address

ISD Name	ESC Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20	County-District Number

Superintendent Name

Superintendent Phone Number

Total Enrollment at Closed School(s)

Number of Staff at Closed School(s)

Are you closing your entire district?

1. Yes
2. No

If "yes" above, what is the first day the entire district is closed?

 [None]  

If your entire district is closing, what is the predicted date for re-opening?

 [None]  

OPTIONAL
If you are closing a campus or campuses, but not the entire district, specify the closing campuses,
closing dates, and their estimated closure lengths here...

Campus	Re-Open Date (mm/dd/yy)	# Days Closed

If you need to specify more campuses, submit this form and begin another.

Press "reset" to clear form data -