Medication Forms

Due to  California Law, EC Section 49423, permits the school nurse or other designated school personnel to "assist" students who must "take" medication during the school day that has been prescribed for that student by their physician.

In order for students to take their "prescribed" medication at school under the supervision of a staff member, caregivers must submit the form below to our EV Main Office Email.

Unfortunately we can not house any medications without having a signed copy of the forms below.

Before any prescription or over-the-counter medication(s) can be administered by Citizens of the World Charter Schools – Los Angeles (“CWC LA”) staff at school this Medication Authorization Form MUST be completed by the student’s parent(s)/guardian(s) and the student’s physician prescribing the medication.

Additionally, it is the policy of Citizens of the World Charter Schools – Los Angeles (“CWC LA”) that any pupil who is required to take medication during the regular school day may self-administer the medication only ifthe School receives: 

(1) A written statement from the physician detailing the name, method, amount, time schedules, discontinue date, any known drug allergies or reactions of the medication, and confirmation that the medication may be self-administered.

(2) A written statement from the parent or guardian consenting to the self-administration, providing a release for the School to consult with the student’s physician/health care provider, and releasing the School from liability.