COVID-19 Travel Disclosure Form

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COVID-19 Travel Disclosure Form

If you have traveled or are planning to travel, please answer the following questions.
All responses will remain confidential and will only be visible to College Administration.
Expect communication from Dr. Alethea Stovall or Melinda White RN, Health Nurse .

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* Indicates required question

Email *

Your email

Student Name *

Your answer

Student Email *

Your answer

Academic Program *

Your answer

Please list all the places you traveled to, including flights, cruises, country, state and city *

Your answer

Start date of travel *

MM

/

DD

/

YYYY

End date of travel *

MM

/

DD

/

YYYY

A copy of your responses will be emailed to the address you provided.

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