Student Pre-Check Health Questionnaire  
This is a mandatory questionnaire to be filled out by the student before checking in. Please answer the following questions at least 72 hours before arrive on campus for your check-in time.
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Email *
Student Identification Number: (ex: P000XXXXXX) *
First Name: *
Middle Name: *
Last Name: *
Within the last 10 to 14 days have you been tested for COVID 19?  (This does not include the 72 hour testing required to return to campus.) *
If you have been tested in the last 10-14 days, what was the result of the test? *
In the past 10 days have you been in close contact with or have you lived with someone who has been directed to quarantine as they await COVID test results or who has symptoms of COVID 19 or who has tested positive for COVID 19? *
If you answered yes to the question above, have you been following the CDC guidelines for self-quarantining? *
In the last 24 to 48 hours have you experienced any COVID 19 related symptoms such as: cough, shortness of breath, difficulty breathing, fever (100.4 or higher), chills, repeated shaking with chills, muscle pain, headache, sore throat, nausea, vomiting, diarrhea, unusual fatigue or the new loss of taste or smell? *
If you answered yes, have you reached out to your healthcare provider? *
If you have been sick recently with a different diagnosis, what was the nature and identification of this illness? (N/A if not applicable)   *
Do you have LifeSafe downloaded on your phone? *
If we offered a free campus wide COVID-19 testing event, would you participate? *
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