COVID-19 Self-Reporting

Please complete the from below if you have been diagnosed with COVID-19 or have had direct exposure to an individual with COVID-19. Student submissions will be shared with the Dean of Students Office and employee reports will be shared with the Office of Human Resources.


(if applicable)

Confirmed COVID-19 Case
I have tested positive for COVID-19

Assumed COVID-19 Case
I have met with my healthcare professional who believes I have COVID-19 but I haven't been tested or am awaiting the results

Exposure to COVID-19 Case
I was in close contact with someone with a confirmed case or someone with an assumed case of COVID-19

Recovered
I had a confirmed or assumed case from which I've recovered. I'm past the 14-day self-isolation period

(if known)

(if known)

Yes    No





Yes    No

  • Free from fever without the use of fever-reducing medications for at least 24 hours.
  • It has been at least 10 days since the onset of the patient's illness.
  • Symptoms improved

  • OR

  • Have two negative COVID-19 tests in a row, with testing done at least 24 hours apart.
Read More About CUC's COVID-19 Response Online
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