Name
First Name
Last Name
Cell Phone Number
Please enter a valid cell phone number.
Email
example@example.com
1) In the past 24 hours, have you experienced any of the following symptoms? (Please check either the "Yes" or "No"), If symptoms such as shortness of breath are due to a known, non-worsening chronic condition, mark "No".
Symptom
Cough
*
Shortness of Breath
*
Fever
*
Chills
*
Fatigue
*
Sore Throat
*
New Headaches
*
New Loss of Taste or Smell
*
2) In the past 14 days, have you tested positive or been infected with Coronavirus (COVID-19)?
*
3) In the past 24 hours, to your knowledge, have you come in contact with anyone who has tested positive or been infected with Coronavirus (COVID-19)?
*
Assumption of Risk and Liability
If you answered "Yes" to more than one of the questions listed above, access to our campus will be denied at this time. We thank you for your understanding of the University’s need to keep you, our faculty, staff, students, and our community safe.
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