Student COVID-19 Reporting

Student COVID-19 Reporting

This form is to be completed by students who have tested positive for COVID-19.
Thank you for reporting your positive COVID-19 results. Health and safety remain our number priority. Our hope is that you have a full and speedy recovery. Once you submit this form and a copy of your positive diagnosis, you may expect a call from Dr. Patricia Wilson, Vice President of Student Services, or her assistant, Ms. Tina Cooper within 48 hours.
Name*

First NameLast Name
A#*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Calhoun Email Address*
example@calhoun.edu
Date Your Symptoms Began*

MonthDayYear
Date
Most Recent Date you were On Campus/Lab/Clinical*

MonthDayYear
Date
Upload a copy of your confirmed positive diagnosis here.*

Cancelof
If you have been on one of Calhoun’s campuses, please list all locations (i.e. classrooms, labs, breakrooms, other) that you have occupied.
List all classes that you are currently attending (DL, hybrid, on campus). Include instructor(s) name.
List individuals (at Calhoun) with whom you have been in CLOSE CONTACT while not practicing social distancing (within 6 feet, for a cumulative total of 15 minutes or more over a 24 hour period). If none, please state "none".*
All information provided on this form helps enable school officials to act quickly and with certainty when addressing matters that affect the health or safety of students or other individuals at Calhoun Community College. Privacy of each student is maintained pursuant to all FERPA and HIPAA guidelines. For more information, please click here.
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