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* 1. What is your name?

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* 2. What is your Jewell ID number?

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* 3. What is your email address where we can send confirmation and information about this testing?

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* 4. Identify your status at the College:

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* 5. If you are a student, identify your residential status.

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* 6. Have you tested positive for COVID 19 since August 20, 2020

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* 7. Indicate the day you will take the test:

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