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

StudentFacultyStaff
Department
Date Tested*

MonthDayYear
Date
Were you tested positive or negative?*

PositiveNegative
If available, please upload a copy of your test result

Browse Files

Cancelof
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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