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Travel Questionnaire
Demographics
Given Name
Last Name
Institute Status
- Select -
Faculty
Member
Visitor
Staff
Other (i.e. short-term scholar)
Email Address
Mobile Phone Number
Please enter the number where you can be reached immediately, if necessary.
Visit Details
Which IAS school/program are you visiting?
Which IAS school/program are you visiting?
- Select -
School of Historical Studies
School of Mathematics
School of Natural Sciences
School of Social Science
Program in Interdisciplinary Studies
Director's Office
Staff
Other…
Enter program name
Are you a...
Are you a...
- Select -
Visiting Scholar
Family member of a current member or faculty member
Current Member
Faculty
Staff
Other…
Please explain
What is the nature of your visit?
How long are you planning to be on campus?
Additional Questions
1. Do you have symptoms of COVID-19, such as fever, chills, cough, shortness of breath, head or muscle aches, sore throat, new loss of smell or taste, nasal congestion/runny nose, nausea, diarrhea or vomiting?
Yes
No
2. Are you feeling ill with any symptoms not mentioned above?
Yes
No
3. Do you have a fever?
Yes
No
4. In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms?
Yes
No
5. In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19?
Yes
No
6. In the past 10 days, have you traveled either domestically or internationally?
Yes
No
7. Are you fully vaccinated? The definition of fully vaccinated is two weeks after you have received the second dose of a 2-dose series or two weeks after you have received a single-dose vaccine.
Yes
No
