2023 Post-Convention COVID Reporting Form
Please take a COVID test ASAP and fill out this form to notify us of your status. If you test again and your status changes, please submit this form again.
Name
*
First Name
Last Name
DSA Membership Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Did you attend 2023 DSA or YDSA Convention?
*
DSA
YDSA
Both
Which of these describes you?
*
Delegate
Alternate
Observer
Volunteer
Speaker/guest
DSA and/or YDSA Chapter
*
If you're an At-Large member, type At-Large. If not applicable, type N/A.
Since attending the DSA and/or YDSA Convention, have you experienced any cold or flu-like symptoms (to include fever, cough, shortness of breath or difficulty breathing, sore throat, pressure in the chest, extreme fatigue, earache, persistent headache, diarrhea, vomiting, muscle pain, chills, repeated shaking with chills, and persistent loss of smell or taste)? If you answer yes, we suggest that you get tested immediately.
*
Yes
No
Have you taken a COVID test since returning from Convention?
*
Yes
No, but I will test ASAP
No, and I don't plan to test
If you tested, what is your result?
*
Positive COVID Result
Negative COVID Result
N/A
Is there anything else we need to know?
Submit
Should be Empty: