Qubit COVID-19 Reporting Form

Please use this form if you suspect you are infected with COVID-19 or have come in contact with someone who is infected. Whether you have been tested or not, please complete the form.

Please do not come to campus if you are experiencing symptoms or have tested positive. You will receive follow-up on this form submission from the COVID-19 Response Team.

Name

Please enter your full name

Cell Phone

Office Location

Home Address

Please enter your home address

School Affiliation

Campus Housing Address

Are you experiencing symptoms of COVID-19?

Have/Do you:

Been tested and given a confirmed result showing you have COVID-19?

Think you have COVID and have not been tested

Been identified as a contact to a known case and are seeking a testing