Fillable Student Attestation Regarding COVID-19 (Anne Arundel Community College)

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Student Attestation Regarding COVID-19 (Anne Arundel Community College)

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Updated October 22, 2020
Student Attestation Regarding COVID-19
To protect the safety and public health of the AACC campus and community, Anne Arundel Community
College (“AACC” or “College”) requires that all students sign and return this attestation to attend classes,
receive student services, or conduct other activities on property owned, leased or operated by the College
(“Campus”).
By signing below, I attest to the following:
• I will not come to Campus if I am experiencing or have experienced any of the following
symptoms for the ten (10) days prior to coming to Campus: (1) fever or chills; (2) cough; (3)
shortness of breath or difficulty breathing; (4) fatigue; (5) muscle or body aches; headache; (6)
new loss of taste or smell; (7) sore throat; (8) congestion or runny nose; (9) nausea or vomiting;
(10) diarrhea; or (11) any other COVID-19 symptom identified by a federal or Maryland public
health agency (“Symptoms”).
• I will not come to Campus if I have had a positive COVID-19 test result on a test that was within
the fourteen (14) days prior to coming to Campus. A COVID-19 test means an FDA Emergency
Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA or other test
approved by CDC or FDA (“test”).
• I will not come to Campus if I am aware of having been exposed to a person with a suspected or
confirmed COVID-19 case. For purposes of attesting to this paragraph, exposure means having an
intimate partner, housemate or giving care to a person who has a suspected or confirmed case of
COVID-19.
o Suspected case means experiencing or having experienced symptoms within the last ten
(10) days and includes the 48 hours prior to the person experiencing symptoms.
o Confirmed case means had a positive test result on a COVID test that was conducted within
the last fourteen (14) days.
• If I experience symptoms, have a positive test result or have been exposed to a person with a
suspected or confirmed case of COVID-19 and will submit a report to COVIDsafety@aacc.edu within
twenty-four (24) hours of any of these situations occurring and will notify my instructors. This duty to
report includes any exposure to a person with a suspected or confirmed COVID Case, including but
not limited to an intimate partner, housemate or caregiver or otherwise coming into contact with
someone with a suspected or confirmed COVID case. Please report any exposure unless you were
wearing personal protective equipment (“PPE”) when the exposure occurred. PPE means personal
protective equipment as defined by the CDC, such as an N95 respirator or medical facemask. PPE
does not include cloth face masks or face shields.
• I will immediately leave Campus if I experience any of the symptoms, have a positive test result, or
have been exposed to a person with a suspected or confirmed case of COVID-19 and will submit a
report to COVIDsafety@aacc.edu immediately and will notify my instructors.
• Every time I come to Campus, I am attesting that I am not currently experiencing symptoms and have
not experienced symptoms in the previous ten (10) days, have not had positive test result from a test
taken in the previous fourteen (14) days and have not been exposed to a person with a suspected or
confirmed case of COVID-19 within the previous fourteen (14) days.
• I will wear a cloth face mask at all times when on Campus, unless I have received an accommodation
through Disability Support Services.
• I will practice social distancing (i.e. remain 6 ft apart from others) to the greatest extent possible
while on Campus.
• I will comply with all applicable Executive Orders by federal, State and local governments and will stay
apprised of other directives, advisories, such as travel advisories, and guidance from federal, State,
and local public health agencies and health departments.
• I will comply with all protocols, directives, policies, procedures, guidelines or guidance provided by
AACC related to COVID-19, which may be more restrictive the government orders.
• I acknowledge and agree that if I experience symptoms, have a positive test result or have been
exposed to a person with a suspected or confirmed case of COVID-19:
1. I will notify the College immediately by emailing COVIDsafety@aacc.edu.
2. I will respond to requests for information from the appropriate local health department and
AACC regarding my circumstances related to COVID-19.
3. I will monitor my AACC-issued email account for information regarding my circumstances
related to COVID-19 and return to Campus criteria.
4. I will follow the CDC and appropriate local health department guidance for isolation or
quarantine.
5. If requested by AACC, I will provide AACC with a copy of negative test result, a letter or email
from a State or local health department or health care provider that states that I may
discontinue isolation or quarantine, a further attestation on a form provided by AACC or any
other documentation requested by AACC by submitting such documentation to
COVIDsafety@aacc.edu.
6. I will not return to Campus until the Manager, Health & Wellness Center or designee has
approved my documentation and return to Campus in writing (via letter or email).
Signature ______________________________ AACC ID # ______________________________
Name ______________________________ Date ______________________________
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Records and Registration office / 410-777-2243 / records@aacc.edu / Register online through MyAACC https://portal.aacc.edu
Please Print Clearly and Complete all Fields TERM: FALL WINTER SPRING SUMMER YEAR: __________________
(Aug.-Dec.) (Dec.-Jan.) (Jan.-May) (May-Aug.)
AACC ID#
Middle Initial ______First Name ______________________Last Name _______________________________________________________________ _________________________ ____
State ________ Zip Code __________City ______________________Address ________________________________________________ _____________ __ County __________________
Phone ____________________________ E-mail __________Major ________________________________________________ ______________________________________
Home Business Cell
Action:
Register, Drop,
*Withdraw, Audit
Depart-
ment
Course
Number
Section
Number
Title
Credit
Hours
Start
Date
Time
Location
(Arnold/MC, AMIL,
GBTC, CCPT, etc.)
Register
SAM
111
001
Sample Course
3
8/28
9-9:50 am
AMIL
I request the course(s) indicated above. By my signature, I acknowledge:
My responsibility for payment of the tuition and fees generated by this registration. I understand that I must pay my bill or
make arrangements to pay by the due date and that I am responsible for all charges unless I drop my classes by the last day
to drop with a full refund as published in the Schedule of Classes.
I understand that auditing or withdrawing may affect my ability to receive financial aid.
I understand that I am responsible for the course(s) selected and understand how they apply toward my educational goal.
By proceeding with this registration I agree to abide by the Academic Integrity Policy and all other college policies as cited in
the College Catalog.
I understand that attendance on the first scheduled meeting day of class is important for success.
Date _________________________________________________ ____________________Student Signature ___
Adviser’s Signature ______________________________________________________ Date ____________________
*IF WITHDRAWING FROM A CLASS
I confirm that I intend to stay enrolled and attend my
other classes that have not yet started during this term.
I am not registered for or plan to drop my other classes
that have not yet started during this term.
Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410-777-2306 or Maryland Relay 711, 72 hours in advance to request
most accommodations. Requests for sign language interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual
misconduct, discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or Maryland Relay 711.
.
REV. 04/2019
CREDIT COURSE REGISTRATION
◆
ADD
◆
DROP
◆
AUDIT
◆
WITHDRAW FORM
PAYMENT INFORMATION
Payment is due at time of registration. Payments can be
made through MyAACC or at the cashier’s office.
Visit www.aacc.edu/tuitionfees/ for information on payment options.
Students using Veterans benefits should contact the Financial Aid Office
upon registration.
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Student Attestation Regarding COVID-19 (Anne Arundel Community College)

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Completed 28 January 2021

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