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Covid-19 Symptoms Declaration

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.

Covid-19 Symptoms Declaration

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Student ID

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Full Name

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City of studies

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

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

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

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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.

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

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