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COVID-19 Informational Form


This form is for members of the campus community to report information regarding the Coronavirus Disease 2019 (COVID-19). Individuals may use this form to report possible contact with COVID-19, academic issues as a result of becoming virtual and more. Please fill out all of the fields below. University staff will follow up with you to provide additional information and resources.

If you are experiencing symptoms of COVID-19 (fever, cough, shortness of breath), please contact your primary care provider. Students who do not have a primary care provider may contact Student Health Services at 805-437-8828

For more information on the University's response to COVID-19, please see our website

Contact Information

 
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Impacted Individual(s)

Involved party 1

Additional Information

Please answer the following questions so that we may best assist you or the individual you are referring.

1. I am reporting about myself or someone being exposed, contracted or suspects to have COVID-19:(Required)
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2. Has the person you are reporting about tested positive for COVID-19?(Required)
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4. Has the person you are reporting about had any symptoms?(Required)
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6. Did the person you are reporting about have contact with someone who was known to have COVID-19 or had symptoms?(Required)
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7. What is the vaccination status of the person you are reporting about?(Required)
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8. The individual I am reporting about, currently resides on-campus in Student Housing:(Required)
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11. If you are reporting about someone else, do they know you filed this report?(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission