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REMAIN AT CATAWBA
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Self-Reporting Form for Students

Any and all information gathered through Catawba College’s reporting process will remain as private as possible. See The U.S. Department of Health and Human Services for specific regulations around privacy and confidentiality and The U.S. Department of Education for specific regulations related to student privacy. The reporting requirement will allow Catawba College to provide education, guidance, and care monitoring to the individual(s) impacted and for the greater campus community.

The information submitted on this form will go to the Dean of Students, Public Safety, Director of Housing, the Health Center RN, the Associate Provost, the Head Athletic Trainer, and the Director of Athletics.

Individual Completing this Form


Report Information


Please provide information on how, where and under what circumstances you came into contact with someone who may have had COVID-19.

PLEASE PROVIDE INFORMATION REGARDING PERSON(S) BELIEVED TO BE AFFECTED BY COVID-19:

Additional Information

Dates believed to have been in contact with someone affected by COVID-19 (please provide calendar dates)

Acknowledgement


I acknowledge by submitting this form, that I will not be allowed to return to Catawba College until at least 10 days have passed since my symptoms first appeared or direct exposure was reported, and at least 24 hours have passed since my last fever without the use of fever-reducing medications. After the 10 calendar day period, I will be notified by the Dean of Students of my return date to class, if I am not showing symptoms of COVID-19.

By submitting this form, I am self-quarantining. I am also notifying the College that I am aware that I must receive written approval from the College prior to returning to campus.

I attest the information provided is true and correct to the best of my ability and understand that any false statements/allegations may be subject to disciplinary actions including but not limited to expulsion or termination.
* = Required Field