Language
English (US)
COVID-19 Travel Notification Form
ONLY for Faculty / Staff
Name
First Name
Last Name
Group
Faculty
Staff
Reason for Travel
Academic
Leisure
Professional
Other (specify below)
(if other please specify)
Date of Travel
-
Month
-
Day
Year
Date
Return:
-
Month
-
Day
Year
Date
Destination Airport
Destination City
Layover stops (if any. Airport & City)
Flu like symptoms upon return
No
Yes (specify below)
if YES, specify:
Please verify that you are human
*
Submit
Should be Empty:
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