- University Preparation Charter School at CSU Channel Islands
- Standard Health Forms

Phone:
Email:
Degrees and Certifications:
Sandy Sontag
Student Support Services
Health Tech
SSontag@pleasantvalleysd.org
805-482-4608 Fax 805-512-8149
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Anaphylaxis Emergency Care Plan
Must have this form and the Medication Authorization form to have an EPI Pen kept on Campus
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Asthma Care Plan
Second form that must be filled out by Doctor for students with Asthma.
You must also turn in Medication Authorization Form
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Student Authorization to Self Carry Inhaler
Parent fill out and Admin approves. Doctor must check the box on the Astma Care Plan that "States Student may care own Inhaler"
5141.23_E-2_Student_Agreement_Asthma_Management_1-2018_w-SP.pdf 215.44 KB (Last Modified on August 19, 2020) -
Return to School with Injury Limitations
Must be fill out by Doctor prior to reurn to school after an Injury