COVID-19 Screening Online-Only Student Exemption Request
Use this form to request an exemption from participation in the COVID-19 screening program if you are a student who will only attend online classes and have no physical presence on campus during the Spring 2021 semester. Once you submit this form, your request will be reviewed by our Dean of Students Office and you will receive a response as soon as possible.
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Email *
Your name (first and last, please): *
What is the best phone number for us to reach you? *
Bengal ID: (This is listed under "ISU ID" in Bengal Web for faculty/staff and students. If you do not have a Bengal ID, enter "NA") *
What is your affiliation with ISU? (select all that apply) *
Required
Please select which of the following best describes your spring semester class situation: *
If granted an exemption, do you agree to comply with the guidelines of the mandatory COVID-19 screening program? This includes attending classes online-only and not having a physical presence on campus throughout the spring 2021 semester. *
If granted an exemption, do you agree that if your situation changes at any point during the semester, you will contact the Dean of Students Office immediately to be enrolled in the COVID-19 mandatory screening program? *
A copy of your responses will be emailed to the address you provided.
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