COVID-19 Student Self Reporting Form

  • Students: Please complete this form ONLY if you have tested positive for COVID-19. Responses will be submitted to the Vice President of Student Services, and your name and contact information will be shared with the local health department for contact tracing purposes. The health department will contact you to identify others with whom you have had close contact. The identified parties will be notified only that they have been in contact with someone who tested positive for COVID-19; names and identities will not be shared.
  • Name * Required
  • Please include leading zeros. The full ID # should be 7 digits long.
    This can be found on your student ID card.
  • Address * Required
  • Date Format: MM slash DD slash YYYY

  • Date Format: MM slash DD slash YYYY