Student | Health Services COVID-19 Symptom Report

First Name

Last Name

ETBU email address

Phone

What residence facilities do you live in?

Do you have roommates?

What are your roommates first and last names?

Report Type

Are you an athlete?

Please list your Head Coach

Select One

What date did you have your test?

Upload Picture of Positive Test Result

Unlimited number of files can be uploaded to this field.
50 MB limit.
Allowed types: gif jpg png svg jpeg.

**If you take an at home test, then you must write your name and test date on the test cassette for your test to be valid and accepted by the health clinic**