Asthma School Health Care Plan

If your child has Asthma (seasonal, mild or severe), you will need the following forms:

Please submit School Asthma Action Plan and the state required Asthma Self-Administration form annually.

Asthma Action Plan and Self Administration Form

Asthma Self-Administration Form ( Spanish)

Asthma Action Plan ( Spanish)

If your child’s asthma is severe or you would like assistance to administer an inhaler from school personnel please fill out these additional forms.

Daily Medication Administration Sheet- (If school staff needs to administer) 
Prescription assistance programs for students and adults with asthma.
Once your at the sight click on Asthma Basics, then click on Prescription assistance.


Return forms to your school's front office