School Forms

For your convenience, the following school forms are available for download as well as from your school:

School Health Form

Student Absence Form



The Waterbury School Nurses are standardizing around the use of either of 2 new (interchangeable) forms developed by the CT State Departments of Education and Public Health.  The new standardized forms combine authorization for medication in schools for up to 3 Asthma medications into 1 overall Asthma-specific form, which is an improvement over previous use of 1 authorization form per medication.  As a valuable added benefit, the combined Asthma authorization form also incorporates an Asthma Action Plan which provides the providers’ directions to all care givers for the specific child with asthma.


Please see the 2 new standardized Asthma forms at the following links:  

NEW ASTHMA FORMS: Your healthcare provider may use EITHER form:
 1. Asthma Medication Authorization and Asthma Action Plan
 2. Asthma Action Plan & School Medication Authorization


Waterbury Public Schools
236 Grand Street
Waterbury, CT 06702
Phone: (203) 574-8000

Fax: (203) 574-8010