COVID-19 Positive Reporting Form
COVID-19 Positive Reporting Form
Use this form to report if you have had a positive COVID-19 Test.
PLEASE STAY HOME AND ISOLATE.
Name
Name
*
First
Last
Medaille ID Number
*
Must be
8
digits.
Currently Entered:
0
digits.
College Email
*
Phone
Phone
*
-
###
-
###
####
College Affiliation
*
College Affiliation
Student
Faculty/Staff
Campus Affiliation
*
Campus Affiliation
Buffalo
Rochester
N/A (Online)
Do you live in the residence halls?
*
Do you live in the residence halls?
Yes
No
Are you affiliated with Medaille College Athletics?
*
Are you affiliated with Medaille College Athletics?
Yes
No
Please upload your lab result. It must include your name, date of test, and result.
*
Attach Files