Spring 2022 Required COVID-19 Documents

This form is available for uploading required COVID-19 testing or vaccination documentation.

All Students, Faculty, and Staff will be required to either:

A. SUBMIT A NEGATIVE COVID-19 TEST
Submit a negative COVID-19 test result and participate in a random COVID testing protocol in order to participate in classes or work on campus.

The COVID-19 test must be an antigen or PCR test from an approved medical facility with documented and dated results.

Students: Test results must be administered no more than seven days prior to arriving to the University of Evansville or Stone Center for Health Sciences campuses. Test results should be submitted no later than two days prior to planned arrival to campus.

Example: If you live on campus and plan to move in on January 8, your test must be administered no sooner than January 1.

Example: If you live off-campus, your test must be administered no sooner than January 3 as classes begin on January 10.
Faculty and staff: Test results must be administered no more than seven days prior to the start of the fall semester. The semester begins January 10, therefore tests must not be administered sooner than January 3. Test results should be submitted by January 8 to provide time for processing).

Additional information regarding the required fall Random COVID-19 Testing Program will be provided.

B. SUBMIT FULL VACCINATION DOCUMENTATION
Submit documentation that you have received the full vaccination for COVID-19, 14 days or more before arriving on campus.

NOTE: If you have previously submitted to the university your fully vaccinated record, you do not need to resubmit it.

Submitting new documentation: Those who submit documentation of being fully vaccinated do not need to submit a negative test and will not be required to participate in the Random COVID Testing Program.

For Pfizer and Moderna vaccinations, a validated certificate of a second shot of the vaccination must be submitted prior to your return. If you have only received one shot, a validated negative test must be supplied.

For Johnson and Johnson, a validated certificate of one vaccine is required.

Students: The last vaccine dose must have been administered at least 14 days prior to planned arrival to campus for students. Vaccine documentation should be submitted no later than two days prior to planned arrival to campus.
Faculty and staff: The last vaccine dose must have been administered at least 14 days before the start of the spring semester (semester begins January 10, therefore vaccine documentation must be dated no later than December 27).

C. SUBMIT PREVIOUS POSITIVE TEST RESULT
Submit documentation of having COVID-19 in the last 90 days (not currently ill) with the date of the diagnosis clearly displayed. Individuals providing this information agree to participate in a random COVID-19 testing protocol in order to participate in classes or work on campus.

If test results are older than three months, please follow option A.

The COVID-19 test must be an antigen or PCR test from an approved medical facility with documented and dated results.

The individual must not have an active case of COVID-19 and must not have symptoms before submitting any documentation for clearance.

Previous positive test results should be submitted no later than two days prior to planned arrival to campus.

Additional information regarding the required fall Random COVID-19 Testing Program will be provided at a later date.

D. REPORT PARTICIPATION IN ALL ON-LINE COURSES
Students confirm that they are enrolled in ALL ON-LINE COURSES with no obligation to visit the University of Evansville campus, or the Stone Center for Health Sciences campus.

Students participating in on-line courses are not required to submit a negative COVID test prior to beginning classes for the fall semester if they will not be on the respective campuses during the Fall semester.

___________________ ___________________

Submitting Negative Test Results or Vaccine Documentation
Individuals will need to upload their documentation below and will receive an email confirmation of receipt within 24-48 hours.

Students: The University will notify professors that a student has met the requirements set forth by the Coronavirus Task Force and is allowed to fully participate in classes. If required documentation is not provided, the student will not be allowed to attend classes. (Note: The University will not disclose specific COVID-19 testing or vaccination status to faculty.)

Faculty and Staff: The University will affirm to the employee’s supervisor that the employee has met the requirements set forth by the Coronavirus Task Force. (Note: The University will not disclose specific COVID-19 testing or vaccination status to supervisors.) If required documentation is not provided, the employee will be subject to the policies as provided by the office of Human Resources.

University Affiliation:*

I am a faculty or staff member (includes students who are professionally employed by UE)I am a student

Are you a:

Name*

First NameLast Name

UE ID*

ex: 0123456

UE Email*

Confirmation Emailconfirm email by entering twice

Mobile Phone Number

Please enter a valid phone number.

Department:*

Supervisor's Name*

First NameLast Name

Do you live on or off campus?*

OnOff

Which building do you live in?*

Room (or House/Apartment) Number

Step 1: Complete the information below:*

Submitting Negative Test Result: I received a negative COVID-19 test result no more than 7 days prior to my scheduled arrival or start of classes. I am uploading documentation.Submitting documentation of being fully vaccinated.Submitting previous Positive Test Result: I have received a documented test result for COVID-19 within the past 3 months and am now cleared from isolation. I am uploading documentation regarding that test.Enrolled in ALL ON-LINE COURSES and have no obligation to visit the University of Evansville campus, or the Stone Center for Health Sciences campus

I have had the vaccination selected below:

Pfizer or Moderna Vaccination (must provide a validated certificate of a second shot of the vaccination*. If you have only received one shot, a validated negative test must be supplied.Johnson and Johnson Vaccination*

*Your last vaccine dose must have been received at least 14 days before your scheduled date to arrive on campus.

Comments or clarifications:

Leave blank if you have no pertinent information.

Step 2: Indicate your testing or vaccination date and your planned arrival to campus:

When was your test or vaccine administered?*

Date

When are you planning to return to campus / start classes?*

Date

Note: Please submit the Exposure, Testing, or Confirmed Diagnosis form if:

You are not fully vaccinated and have had a recent close contact exposure to someone known to have COVID-19
You have received a positive result from a recent COVID-19 test.

Students - Submitting Documentation

For Negative Test uploads:
If your negative test results were administered more than 7 days prior to your planned arrival, you must submit a more recent test that fits within that window of time. Please exit this survey if this is the case.

For documentation related to the Pfizer and Moderna COVID-19 vaccine:
If you only have had the first shot, please submit a negative test result administered no more than 7 days prior to your planned arrival.

For documentation that you have had COVID-19 in the last 90 days:
If your test results are older than three months, you should not upload that result. Instead, please submit a negative test result administered no more than 7 days prior to your planned arrival.

Faculty/Staff - Submitting Documentation

For Negative Test uploads:
If your negative test results were administered more than 7 days prior to January 10 (before Before January 3), you must submit a more recent test that fits within that window of time. Please exit this survey if this is the case.

For documentation related to the Pfizer and Moderna COVID-19 vaccine:
If you only have had the first shot, please submit a negative test result administered no earlier than January 3.

For documentation that you have had COVID-19 in the last 90 days:
If your test results are older than three months, you should not upload that result. Instead, please submit a negative test result administered no earlier than January 3.

Step 3: Upload your documentation here: *

A documented negative result administered 7 days prior to arrival (or a cleared diagnosis in the past 3 months) will provide a student with a pass to move on campus and/or attend in-person classes.

Step 4: Indicate the medical provider / facility that administered your test / vaccine:*

I certify that the information I have provided about participation in On-Line Only courses and activity is true and accurate.*.

Step 5: Certify your information:

I certify that the test / vaccine documentation I have submitted was provided to me through a medical provider or facility licensed to administer COVID-19 testing or vaccine administration. *

*Your initials/signature certify that the above statement is true. *

* Falsifying documentation related to COVID-19 testing / vaccine administration or information regarding on-line only participation will result in University Disciplinary action.

Following review of your submission, you will receive a confirmation within the next 24-48 hours.