* Name of district/college/facility:

* State:

* Name of person completing the form:

Name of your union:

Position in the union:

* Email contact:

* Enter email again

Phone:

* Is the entire district, college or facility closed?

Total number of students affect (your best estimate):

Total number of staff affected (again, your best estimate and include teachers, support staff and administrators)

What day/date did schools close?

How long will schools be closed?

Does your district or college have an emergency procedure in place for closures for health reasons?

Can we contact you for additional information? (If yes, please be sure to include your email address above)