Registrant Information Will you be using this COVID-19 test result for travel related purposes? * If you are registering for COVID-19 travel related testing, you must make it to your registered date at the Koblerville Youth Center. Please see the following schedule for travel testing at the Koblerville Youth Center:
Monday - Sunday: 8:30AM - 11:00AM
If you are using this test for travel purposes, please include your Passport or ID No.
CHCC and the Governor's COVID-19 Taskforce advises all travelers to check their final destinations' COVID-19 entry requirements and airport and airline requirements for PCR testing.
Airlines or your travel destination may require an official stamp or seal on your COVID-19 test result certificate. Please print your results and bring it with your itinerary to the Koblerville Youth Center to be officially stamped. Open Monday - Sunday from 8AM - 11AM. Test results are generally available for pickup the following day after you have been swabbed.
Full Name *
Please use the name indicated on your photo identification (Driver’s License, Mayor's ID, Passport, Birth Certificate, and Student ID). You will need your photo ID throughout your appointment.
Date of Birth *
Notice: If you are under the age of 18, please enter an authorized parent or legal guardian. (additional verification may be required)
Hidden Age Gender * Please select a choice Male Female Prefer not to say What is your ethnicity? * Please select a choice Chamorro Carolinian Filipino Japanese Korean Chinese Hispanic White Black or African American Other Prefer not to say Other (Ethnicity) * Parent or Legal Guardian Information Parent or Legal Guardian Full Name *
Date of Birth (Parent or Legal Guardian) * Hidden Age (Parent or Legal Guardian) Contact Information Phone Number (Select all that apply) * Home Phone * Confirm Home Phone * Mobile Phone * Confirm Mobile Phone * Work Phone * Confirm Work Phone * Email Address *
Please note that the email address entered will be used to send your COVID-19 test results.
Contact Tracing - Residence Location Village (Saipan) * Please select a choice Achugao Afetnas Agingan As Akina As Falipe As Gonna As Lito As Mahetog As Matuis As Palacios As Perdido As Rabagau As Teo As Terlaje Banaderu Bird Island Capitol Hill Chacha Chalan Galaide Chalan Kanoa I Chalan Kanoa II Chalan Kanoa III Chalan Kanoa IV Chalan Kiya Chalan Laulau Chalan Piao Chalan Rueda China Town Dagu Dandan Fananganan Fanonchuluyan Finasisu Garapan Gualo Rai Halaihai I Akgak I Denni I Fadang I Liyang I Maddok I Naftan I Pitot Kagman Kagman I Kagman II Kagman III Kagman IV Kalabera Kannat Tabla Koblerville Laulau Bay Lower Base Managaha Marpi Matansa Maturana Hill Nanasu Navy Hill Opyan Papago Pidos Kahalo Puerto Rico Sabaneta Sadog Tasi San Antonio San Jose (Oleai) San Roque San Vicente Susupe Talafofo Tanapag Tangke Tapochao Tottotville Village (Tinian) * Please select a choice Carolinas Carolinas Heights Marpo Heights Marpo Valley (Mid East) Northern Tinian San Jose (Tinian Municipality) Western Tinian Village (Rota) * Please select a choice Afatung Agatasi (Payapai) Agusan Alaguan Annex F Apanon As Akoddo As Dudo As Niebes (Nieves) Duge Fanlagon Finata Gagani Gampapa Gaonan Gayaugan (Kaan) Ginalangan (Chudan) I Chenchon I Koridot Lempanai Liyu Makmak Mananana Matpo Mochong Mount Sabana (Minachage) Mount Taipingot Pekngasu Sailigai Papa Sayan Gigani Sinapalo Songsong Tagolo Ogso Taimama Talakhaya Talo Tatachok Tatgua Tenetu Ugis Student Information Are you a student enrolled in a CNMI public/private school, college, or trade school? * Public/Private School * Please select one of the following Agape Christian School Brilliant Star Montessori Chacha Oceanview Middle School Chalan Kanoa Early Head Start Chalan Kanoa Head Start Da'ok Academy Dandan Early Head Start Dandan Head Start Dandan Middle School Dr. Rita Hocog Inos Jr./Sr. High School Eucon International Francisco M. Sablan Middle School Garapan Elementary School Golden Harvest Int'l Grace Christian Academy - Saipan Grace Christian Academy- Rota Green Meadow School Gregorio T. Camacho Elementary School Homeschool Hopwood Middle School Isla Montesorri School Joaquina M Rabauliman Head Start K-5 Childhood Development Center Kagman Elementary School Kagman Early Head Start Kagman Head Start Kagman High School Koblerville Elementary School Korean Community School of Saipan Marianas High School Mount Carmel School Northern Marianas International School Oleai Elementary School Oleai Head Start Rota Head Start Saipan Community School Saipan International School Saipan Joseph School Saipan Southern High School San Antonio Head Start San Vicente Elementary School Seventh Day Adventist Academy Sinapalo Elementary School Susupe Early Head Start Tanapag Eearly Head Start Tanapag Head Start Tanapag Middle School Tinian Elementary School Tinian Head Start Tinian Jr. Sr. High School William S. Reyes Elem. School Grade Level * Please select one of the following Early Head Start Head Start Kindergarten 1 2 3 4 5 6 7 8 9 10 11 12 College/Trade School * Please select one of the following Northern Marianas College Northern Marianas Trade Institute Employment Information Are you employed? * Are you employed by a CNMI Public/Private School or College/Trade School? * Please select one of the following * Employer * Please select one of the following Public School System - Main Office Northern Marianas College Northern Marianas International School Northern Marianas Technical Institute Agape Christian School Brilliant Star Montessori School Chacha Oceanview Middle School Chalan Kanoa Early Head Start Chalan Kanoa Head Start Da'ok Academy High School Dandan Early Head Start Dandan Head Start Dandan Middle School Dr. Rita Hocog Inos Jr./Sr. High School Eskuelan San Francisco de Borja Catholic School Eucon International Francisco M. Sablan Middle School Garapan Elementary School Golden Harvest International School Grace Christian Academy Green Meadow School Gregorio T. Camacho Elementary School Hopwood Middle School Joaquina M Rabauliman Head Start Kagman Elementary School Kagman Early Head Start Kagman Head Start Kagman High School Koberville Elementary School Korean Community School of Saipan Marianas High School Mount Carmel School Oleai Elementary School Oleai Head Start Rota Head Start Saipan Community School Saipan International School Saipan Joseph School Saipan Southern High School San Antonio Head Start Susupe Early Head Start San Vicente Elementary School Seventh Day Adventist School Sinapalo Elementary School Tanapag Early Head Start Tanapag Head Start Tanapag Middle School Tinian Elementary School Tinian Head Start Tinian Jr./Sr. High School William S. Reyes Elementary School Public School System - Main/Central Office Departments * Please select a department Office of Commissioner of Education Finance Procurement Federal Programs Child Nutrition Special Education Accountability, Research & Evaluation Curriculum & Instruction Student & Support Services Instructional Technology & Distance Education State Technology Infrastructure Human Resource Pupil Transportation Facilities Development Management Head Start/Early Head Start State Board of Education Americorps Early Intervention JROTC Who is your employer? * What is your occupation? * Terms and Conditions *
I agree to the terms and conditions of this testing procedure and will follow the rules set forth by the Governor's COVID-19 Task Force and the Commonwealth Healthcare Corporation at the testing site.
Hidden Questionnaire Hidden Have you ever tested previously for COVID-19? * Hidden Date Tested
MM slash DD slash YYYY
Hidden Are you fully vaccinated for COVID-19? * Hidden Reason for getting tested for COVID-19 * Hidden Other - Reason Not Listed - Please Describe * Name
This field is for validation purposes and should be left unchanged.