2026-27 Screening Form B School Health Services Report

2026-27 Screening Form B School Health Services Report

Preparer Information

First Name *This question is required.

Last Name *This question is required.

Job Title *This question is required.

Phone Number - Work Number
Please use format: ###-###-#### *This question is required. This question requires a valid number format.

Phone Number - Summer Contact Number
Please use format: ###-###-#### *This question is required. This question requires a valid number format.

Email Address
Upon completion of this report, you will receive a confirmation email with your report confirmation attachment to this address. *This question is required. This question requires a valid email address.

School Information

Please select the county that your charter school or PSU is located in: *This question is required.

Please select your region: *This question is required.

Please select your charter school from the drop down menu: *This question is required.

Please select your PSU from the Central Region list below: *This question is required.

Please select your PSU from the Northeast Region list below: *This question is required.

Please select your PSU from the Northwest Region list below: *This question is required.

Please select your PSU from the Southeast Region list below: *This question is required.

Please select your PSU from the Southwest Region list below: *This question is required.

Please select your PSU from the West Region list below: *This question is required.

Please upload Screening Form B

Download the Screening Form B spreadsheet provided on the 2026-2027 School Health Services Resources webpage and save it to your computer.
After entering your local information, you must re-save it to your computer keeping the document title (file name) intact and inserting your district name at the beginning of the title.
When you save your document, please check that it is being saved as a "Excel Workbook(*.xlsx)" file. This is located underneath the field to rename the file when saving. The template is already in this format, so the default file type should already be the *.xlsx format.
After compiling responses on the spreadsheet and saving it to your computer, using the correct file name as described above, you will use the "Browse" button provided below to ‘upload’ your spreadsheet and submit the report form.
Click 'Browse' and locate the saved file on your computer.
Note: Attaching the document from a cloud-based account, i.e. Google Drive, is not an allowable function.
Once you have selected the file, it will show in the report survey. It may take a moment to upload into the survey.

File name example: BurkeScreening2026-27.xlsx *This question is required.

File: {{filename}} delete