COVID-19 Self Reporting

COVID-19 Reporting Status Date

mm/dd/yyyy

Student / Employee

Student

Employee

First Name *

Last Name *

RAM ID (900#) (Student and Employee) *

Phone Number *

Email Address *

Last day on campus *

mm/dd/yyyy

Type of Exposure

(If applicable)

From Home

From Work

Out of Town

Exposure Date

(If applicable)

mm/dd/yyyy

File Upload

Please submit your test results/documentation here. Please also submit your COVID-19 Vaccination documentation here as well.

Drop your files here

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