Are you staying on-campus?

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Please make sure to answer the following questions to let the Lodge staff know if you are or are planning to continue living on campus for the Spring 2020 semester. The following questions have been recommended by the Siskiyou County Public Health Department.

First Name *

Last Name *

COS Email *

Are you returning? *

March 29th (end of spring break)

Actually, I'm not returning and will complete an express check out form

Other:

List the general area you traveled to during spring break or during the 14 days prior to your return to campus (if you did not travel - write "did not travel") *

Have you been exposed to any person with a documented case of COVID-19? *

Yes - (stay off-campus until you have a clearance document from your health care provider)

Are you feeling well? *

Yes (you may be screened upon your return to campus)

No (stay off-campus contact your health care provider for a screening and clearance)

If a resident returns to the Lodges and is later determined to be a "person under investigation" they will be required to leave the lodge buildings. The Lodges are not appropriate for isolation/quarantine location. *

I understand

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