COVID-19 Test Reporting Acknowledgment

COVID-19 Test Reporting Acknowledgment

Please use this form to report and record the results of your COVID-19 test results. Information you report will be utilized in making decisions regarding your return to Prescott College Campus Facilities.
Name *

First Name Last Name
Email *
user.name@prescott.edu
I am a: *

Student Faculty Staff
Department
Date Tested *

Month Day Year
Date
Were you tested positive or negative? *

Positive Negative
If available, please upload a copy of your test result

Browse Files

Cancel of
Testing Facility *
Additional Notes
By signing in the box below, I hereby acknowledge that of the above information is true and accurate to my knowledge. I understand that any false reporting could result in dismissal of employment or enrollment in academic programs.
Signature

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