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Series 708.7.1P - COVID-19 Mask Accommodation for Student

In response to the COVID-19 pandemic, District 196 has implemented face mask protocols that are to be followed by students, staff and visitors in any district building, regardless of vaccination status. Students who cannot wear a mask or cannot safely wear a mask because of a disability may use this form to request a reasonable accommodation. The completed form may be submitted to your child’s school building administrator.

This information obtained from this form will be used to determine whether your child qualifies for an accommodation from the district’s mask requirement. You are not required to complete the form. However, if you do not provide the information requested in this form, the district may lack sufficient medical documentation to grant an accommodation. Through submission of this form, you also authorize the school district to contact your child’s health care provider with questions about the completed form.

The information provided in this form will be maintained as private educational data and will only be shared with persons with a legitimate educational interest, which includes but is not limited to school administration, district nursing staff and the school district COVID-19 response team.

For background information about masks and mask accommodations, refer to 708.7AR COVID-19 Masks.

Note: If your child has a disabling condition and you are seeking other information, accommodations and support from the school district beyond a mask accommodation, please contact your child’s school building administrator.