Updated 6/25/2020
Student Attestation Regarding COVID-19
Before returning to the college and any in-person class session(s) or activity, I hereby attest, confirm and
agree to the following:
I am currently asymptomatic without any of the following symptoms: cough, shortness of
breath, fever, chills, muscle pain, sore throat, new loss of taste or smell, nausea, vomiting or
I have had no known potential exposure to COVID-19. I understand that the definition of
potential exposure means being an intimate partner, housemate, or caregiver of, or having
unprotected close contact (less than 6 feet apart for 15 minutes or more) with an individual with
confirmed or suspected COVID-19. The timeframe for having contact with an infected individual
includes the period of time from 48 hours before the individual became symptomatic until they
meet CDC criteria for discontinuing home isolation.
I agree and fully understand that by attending any in-person class session(s) or any other
college activity, I am attesting that my statements above are still true and correct. If at any
point during my attendance at a class or college activity my condition changes so that I am no
longer able to attest and confirm the above statements are true and correct, I will immediately
report this fact to the person conducting the class or activity and will leave the class, activity
and college immediately. I will not return to campus without explicit, written consent from the
I have received and read all required policies and procedures listed on the information card for
the course as attached to the syllabus for my course.
Student ID No.
Student Signature
By signing below, I attest, confirm and agree to the statements above.
Student Signature
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