All students, employees and community partners required to return to classes must complete the COVID-19 Self Declaration Form before arriving at any of our schools.

Student ID

Full Name

City of studies

During the last 14 days, have you had one or more of the following symptoms?

During the last 14 days, did you, or any of your companions have close contact with someone with symptoms?

During the last 14 days, have you or any of your companions had a diagnostic test for COVID-19 with a positive result?

During the last 14 days, have you worked or volunteered in a healthcare facility or as a first responder? Healthcare facilities include a hospital, medical or dental clinic, long-term care facility, or nursing home.

To the best of my ability, I certify answers to the preceding questions are true and correct.