•  HIGH RISK INDIVIDUAL - "At an Increased Risk"
    Complete this form if you fall under the “at an increased risk” of severe illness from COVID-19 as defined by the Governor’s extension of proclamation 20-46.2 and are requesting accommodations. “At an increased risk” includes the following conditions as defined by the CDC:

    • Cancer
    • Chronic kidney disease
    • COPD (chronic obstructive pulmonary disease)
    • Immunocompromised state (weakened immune system) from solid organ transplant
    • Obesity (body mass index [BMI] of 30 or higher)
    • Serious heart conditions, such as heart failure, contrary artery disease, or cardiomyopathies
    • Sickle cell disease
    • Type 2 diabetes mellitus

    HIGH RISK INDIVIDUAL - Resides in Your Household
    Complete this form if an individual that resides in your household is considered “higher risk" of severe illness from COVID-19 as defined by the Governor’s proclamation and are requesting accommodations. 

    EMPLOYEES WHO HAVE HEALTH CONCERNS - Associated with COVID-19
    Complete this form if you are an employee whose assignment requires work at a District work site and who has health concerns associated with COVID-19.