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Returning to Campus Questionnaire
Please answer all questions as honestly as possible to the best of your ability.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Name
*
Your answer
Last Name
*
Your answer
Cell Phone Number
*
Your answer
Class Year
*
First Year
Second Year
Third Year
Fourth Year
In the past fourteen days, have you been in close contact with someone who tested positive for COVID-19?
*
Yes
No
I am not sure.
Has anyone in your household tested positive for COVID-19 in the past four weeks?
*
Yes
No
Please indicate if you have had any of the following symptoms in the past two weeks?
*
Fever
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Persistent pain or pressure in the chest
New confusion
Skin rash or discoloration of fingers/toes
Inability to wake or stay awake
Bluish lips or face
Loss of speech or movement
Conjunctivitis/eye problems (enlarged, red blood vessels, swollen eyelids, excessive discharge)
Light sensitivity and irritation
No symptoms in past two weeks
Required
Do you have any reason to believe that you could be currently infected with COVID-19?
*
Yes
No
Have you/will you be attending any gatherings of 10 persons or more in the two weeks leading up to your arrival on campus?
*
Yes
No
Based on your current situation, what are your initial thoughts on your plans for this fall semester?
*
My plan is to return as planned and begin classes on August 20
My plan is to change some of my classes to online so that I can take all my classes remotely
All of my current classes are online so I plan on taking classes remotely
I plan on deferring for a year
Other:
What is the status of your current room assignment/living situation?
*
Off Campus at the hotel
Off Campus in Northfield
Off Campus not in Northfield
On campus in a residence hall
On campus in an honor house
Still need a housing assignment
Based on additional online courses being offered or your current class schedule, please indicate your anticipated housing preferences.
*
I’d like to keep my current housing assignment on campus.
I would like to change my plans and stay home and to take classes online for the fall semester. (If this is your plan, please contact your roommate about your change in housing plans)
I’d like to keep my current housing plan for off campus
I’d like to change my plans and move from off campus housing to on campus housing
Based on the new restrictions for quarantine, are you currently able to return to campus and move-in by August 19?
*
Yes
No
If no, what is your reason for not being able to return by August 19th
Your answer
Please list any comments or specific questions here.
Your answer
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