Recent/Upcoming Travel Questionnaire
In light of the recent outbreak of respiratory illnesses caused by coronavirus (COVID-19), Miles College, is taking all necessary precautions to help ensure the safety and well being of our community.

To aid in this process, we are asking all students, faculty, staff, and community members to complete this short travel survey to help us monitor and reduce any potential risks. Your privacy is our top priority. This form will only be used for internal tracking purposes.

Since new cases of the virus are being reported daily, we ask that you consult this tracker from John Hopkins University to see if you have recently traveled to any areas in the U.S. or abroad that have reported cases: https://bit.ly/2Iwuo1R

Miles College will continue to monitor the outbreak and follow the recommendations of local and national officials. See our latest news related to COVID-19 here: https://www.miles.edu/news/latest-news
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Email Address *
Full Name *
Contact Number *
I am..... *
Have you recently traveled to a location with recorded cases of COVID-19, or do you plan to travel to one of these locations in the near future? (You can review the map linked above.) *
If you answered yes to the previous question, please provide the dates of your travel. *
Are you planning to travel on a Spring Break (March 22-28, 2020) *
If you answered yes to the previous question, please provide the places of your travel
Please list the country you visited or plan to visit. Please list the city and state for travel within the U.S. *
Have you been in close proximity to a friend or family member who has traveled to a high-risk location? * *
I Would you like to share anything else in regard to your potential exposure to coronavirus?
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