NJIT International Travel Survey
NJIT has established a task force to monitor the global outbreak of the COVID-19 (coronavirus) and is requesting that members of the campus community who have traveled to (within the last 14 days) or have plans to travel to a country with a CDC Level 2 or 3 Warning for coronavirus outbreak complete the form below. We also request that those who have been in contact with others who have traveled to such a location within the last 14 days or plan to be in close contact with people who have plans to travel to any of those locations also please complete the form below. Once the form is submitted and reviewed, the task force will contact any NJIT community member who has completed the form.
* Required
Email address
*
Your email
Have you traveled to a country with a CDC Level 2 or 3 Warning for coronavirus outbreak during the last 14 days?
Yes
No
Do you plan to travel to a country with a CDC Level 2 or 3 Warning for coronavirus outbreak?
Yes
No
Which country do you plan to traveled to?
Your answer
On what date did/will you return to the United States?
MM
/
DD
/
YYYY
Have you been in contact with someone who has traveled to a country with a CDC Level 2 or 3 Warning for coronavirus outbreak during the last 14 days?
Yes
No
Do you plan to be in contact with someone who has traveled to or will be traveling to a country with a CDC Level 2 or 3 Warning for coronavirus outbreak ?
Yes
No
What is your first name?
Your answer
What is your last name?
Your answer
What is your NJIT email address?
Your answer
What is the best telephone number at which to reach you?
Your answer
Which is your primary NJIT affiliation?
Undergraduate Student
Graduate Student
Faculty Member
Staff member
Visitor
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