Please fill out the student breakdown sheet.
Hearing & Vision Screening Program
Student Breakdown by School
Enter your district and list each school with its student counts by grade. Rows total automatically, and grade totals are calculated at the bottom. When you're finished, download a branded PDF and send it to our team.
Step 1 — Charter / District Information
Step 2 — School Entries
| School Name | TK | K | Grade 2 | Grade 5 | Grade 8 | Grade 10 | IEP Evaluations | School Total |
|---|---|---|---|---|---|---|---|---|
| TOTALS | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 2nd Grade Boys | 7th Grade Girls | 8th Grade Boys | |
|---|---|---|---|
| 0 | 0 | 0 |
2nd, 7th, and 8th grade boys' counts are reference points for color vision and scoliosis screening planning and are not included in the School Total.
Step 3 — Notes
School Nursing Solutions Team Notes
Reserved for the SNS team — completed internally after this submission is received.
Step 4 — Submit
One click sends this data straight to our team as a PDF — no email needed.
Your entries are saved automatically in this browser as you type.