University Housing Wellness Form
This form is confidential. Be sure to click "submit" to make your report confirmed and this will also clear information from the screen. The information you are going to share will be sent to you via email once you click "submit."
This report is about:
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Person who received a posititve test result for Covid 19, Flu, or strep throat
Person who has symptoms and has not been tested or is awaiting test results
Person who has been exposed to someone who received a positive test result
Date of positive test or first day of symptoms or exposure
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Month
-
Day
Year
Date
Proof of Positive Test
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Choose a file
Example: Note from Wellness Center or photo of test result
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Information about indidvidual with suspected or confirmed test result or exposure
Name
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First Name
Last Name
Email
*
example@example.com
West or East Campus
Please Select
East Campus (Trueblood Dining)
West Campus (Lentz Dining)
Dawgtag
Number
*
Mobile number
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Culinary and Nutrition Services
Meals will not be delivered to your residence hall or apartment. You can pick up your meals from the dining hall check-in station between 10 am - 12pm for lunch and 5pm - 7pm for dinner. We ask that you wear a mask when picking up your meals. Masks are also available at the checkout station in Lentz and Trueblood. Prepared meals will be a sack lunch consisting of a sandwich and packaged side. Please answer the next few questions so our Culinary and Nutrition Services Team can best accomodate your needs.
Please provide any food allergies that you have
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Vegan
Vegetarian
Celiac Disease
Peanuts
Seafood
Gluten Free
Other
I will pick up my food at the below times. The dates and times will be based on 2 days from your positive test date,syptoms or exposure. If you need additional services, you will need to speak to your Hall Director. Please note if any of these day fall on Saturday or Sunday times will be 11:00am to 1:00pm for the first meal.
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1st day 10am - 12pm
1st day 5pm - 7pm
2nd day 10am - 12pm
2nd day 5pm - 7pm
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