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Where do you currently live?

  • On Campus
  • Off Campus

Do you have an MSOE roommate?

  • Yes
  • No

Are you experiencing any of these symptoms below?

(select all that apply)

  • Fever
  • New onset of dry cough
  • Loss of taste or smell
  • Shortness of breath
  • None of the above

Are you experiencing any of these symptoms below?

(select all that apply)

  • Chills
  • New or unusual headache
  • Nausea or vomiting
  • Diarrhea
  • Sore throat
  • New or unusual muscle aches
  • Congestion/runny nose not associated with a chronic condition
  • None of the above

Have you been in contact with someone who, within 48 hours of your contact, has developed COVID-19 symptoms and/or tested positive for covid-19?

  • Yes
  • No

if yes, were you within 6 feet for 15 or more minutes?

  • Yes
  • No

Have you gotten a COVID-19 Test done in the past 90 days or have one scheduled?

  • Yes
  • No