Influenza Self-Report Form

If you are experiencing flu-like symptoms and would like to seek assistance and support from the Residence Life and Health Services staff members, please complete the following form. Please contact the Residence Life Office at 657.1099 with any questions you may have about resources available to you during your illness. If it is after business hours, please contact the Emergency On Call staff member at 698.8777.
* Required





Never submit passwords through Google Forms.