Parents/guardians of students ages 12 and older who want to participate in remote learning must complete and submit the form below. A student aged 12 and older is eligible for remote learning for the 2021-22 school year only if the Fond du Lac School District receives this form with a statement from a licensed physician, physician assistant or advanced practice registered nurse indicating that the student is at increased risk of severe illness due to a pre-existing condition or has special health care needs (e.g., regular oxygen administration, medically fragile). A student may also be eligible for remote learning if they live with an individual who is at increased risk of severe illness from infection with COVID-19.
Please contact Katie Moder, Director of Pupil Services, with any questions at
(920)906-6520 or by email
Please complete and return this form to the Fond du Lac School District at 72 W. 9th Street, Fond du Lac, WI 54935, by
August 16, 2021 deadline was extended to August 20, 2021.