Weekly COVID-Test

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* 1. Your Name

First Name

Last Name

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* 2. Your Email

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* 3. Select Your Status

Student

Faculty

Staff

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* 4. When did you take the COVID-19 Test?

Date printed on the form

Date

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* 5. Your COVID Test

Your name and test results must be visible

PDF, PNG, JPG, JPEG, GIF file types only.

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* 6. What Classes are you going to Attend On-Campus?

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* 7. Comments