University COVID-19 Onboarding Form
Complete this University COVID-19 Onboarding Form to confirm your readiness and understanding of campus COVID-19 guidelines before returning to campus.
Full Name
*
First Name
Last Name
University Email Address
*
example@example.com
Campus Role
*
Please Select
Undergraduate Student
Graduate Student
Faculty
Staff
Other
Onboarding Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you traveled internationally in the last 14 days?
*
Yes
No
Have you been in close contact with anyone diagnosed with COVID-19 in the last 14 days?
*
Yes
No
Preferred Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: