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COVID-19 Staff Vaccine Verification

Good afternoon Adelanto Elementary School District Employees,

Pursuant to the State Public Health Officer’s Order (“Order”) of August 11, 2021, all K-12 local educational agencies must verify the COVID-19 vaccination status of all employees, volunteers and other adult individuals who work in District facilities no later than October 15, 2021.  Attached is a memorandum that is being sent to all District employees. Please read the entire Memorandum and Attestation Form for your information.

We are asking all employees to submit this information by Friday, October 15, 2021 in order to obtain the exact number of vaccinated, unvaccinated or incompletely vaccinated employees. This information will help us prepare for weekly surveillance testing.

What is required?

  1. All employees must complete the Attestation Form and submit proof/record of their COVID-19 vaccination. Please click this link to submit your information and upload your proof/record of vaccination: Click here ---> Attestation Form

Options for completing this Attestation Form and submission of proof/record of vaccination.

  1. Employees may complete their Attestation Form via the link above and upload their proof of vaccination.
  2. Employees may complete their Attestation Form via the link above and then mail or email their proof/record to Cherie Humphrey  at
  3. Employees may complete their Attestation Form and provide proof/record of vaccination by mailing these documents to Cherie Humphrey.

What if employees select:

I am partially/incompletely vaccinated; 2) I am not yet vaccinated, but vaccination appointment is scheduled; 3) I am not vaccinated against COVID-19; or 4) I decline to attest to vaccination for COVID-19?

  1. Employees must complete the Attestation Form by clicking here ---> Attestation Form
  2. Employees must undergo weekly surveillance testing for COVID-19.

Please be sure to read the entire memorandum and attachments.

Thank you for understanding that the District is legally required to follow the mandatory guidelines of federal, state and local public health authorities.  These precautions are for the protection of the District’s students, staff and community.


Carlos Moran

Official Documents

Memorandum - Employee Notification and Attestation Information re COVID

Staff Attestation Form