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School District of West Salem COVID-19 Dashboard

The below forms can be filled out to request a medical or religious exemption to wearing a mask for a School District of West Salem student. Please note, even if an exemption is granted, only a medical exemption due to a documented disability under the Americans with Disabilities Act (ADA) will allow a student to forego wearing a mask on school buses. All other exemptions are only valid for school district buildings due to the federal order issued by the Centers for Disease Control and Prevention and the Department of Health and Human Services requiring masks on all forms of public transportation. 

*Please note, both forms are fillable, however, they must be printed and signed by hand before submission. Electronic signatures will not be accepted. 
Medical Face Covering Exemption Request Form -please email completed form to District Nurse Kate Brohmer at brohmer.kate@wsalem.k12.wi.us 
Religious Face Covering Exemption Request Form -please email completed form to Superintendent Ryan Rieber at rieber.ryan@wsalem.k12.wi.us

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