Travel Questionnaire

Demographics
Please enter the number where you can be reached immediately, if necessary.
Visit Details
Which IAS school/program are you visiting?
Are you a...
Travel History

Please list all countries/cities abroad that you've been in during the last 14 days.  Please include the United States in the table below. 

Location, including Country Date you were last in this location If you are unable to provide the date, please explain why: City Other City Other City Other City
Additional Questions
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?
Are you feeling ill with any symptoms not mentioned above?
Do you have a fever?
In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms?
In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19?