Bement Community Travel Survey
As the COVID-19 situation around the world continues to evolve, please complete this form before students return to campus for Tuesday, April 14.

The Center for Disease Control and Prevention (CDC) issued level 2 and 3 Travel Health Notices to countries that have widespread sustained ongoing transmission of COVID-19. As of March 13, level 3 countries include China, Iran, Italy, Japan, and South Korea, as well as more than 28 European countries. The CDC recommends travelers from countries with widespread sustained transmission arriving in the United States stay home for 14 days from the time they left the area and practice social distancing.  If students have visited a level 2 or 3 country, even for a layover, they will be required a 14-day separation from the time they left the country.

Thank you for your understanding and partnership during this important time.
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Email Address *
Student First Name *
Student Last Name *
Name of Person Completing This Form *
Did your family travel during the March break 2020? * *
If yes, please list each city, state, or country visited and duration/dates:
Did you travel from another state or country to join your child in the United States for the March break? * *
If yes, please list the country you traveled from:
To your knowledge, have you or anyone in your family been in contact with anyone who may have been exposed to COVID-19? * *
Has anyone in your family been in close contact with an individual who recently traveled from states or countries affected by the CDC Travel Advisories? * *
Thank you for taking the time to complete this form.
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