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Local School Address
Are you symptomatic?
(check all that apply option)
If you have a fever please provide your most recent temperature check?
When did your symptoms begin?
Are you a Close Contact with a person who is symptomatic?
Date of last contact with symptomatic individual?
Are you a Close Contact with a person who is currently positive with COVID-19?
Date of last contact with COVID positive individual?
Have you taken a COVID test since your symptoms started or since your exposure?
Do you have a test scheduled?
If yes, what day is it scheduled for?
Have you had COVID in the last 90 days?
Have you received a COVID Booster?
Booster Date Received:
Please upload vaccination card
Are you fully vaccinated (two weeks past your last COVID-19 vaccine dose)?
Has it been less than six months since you have been fully vaccinated?
Do you have any health information (pre-existing medical condition, allergies, mental health concerns) that would be helpful for us to know as we provide guidance on next steps and if needed, support you during your isolation?
Any additional information you feel our team needs to be aware of
If you live on campus and it is outside of business hours (Monday - Friday, 8am - 4:30pm) please contact your hall director at 414-331-4926, to notify them of your COVID concern