CNU Health Declaration Form
In compliance with IATF regulations, all personnel and external clients of the University are required to fill out contact tracing and health declaration forms. The University reserves the right to refuse entry into its premises any person who fails or refuses to accomplish and submit this form, and who it reasonably deems may pose a risk to other people.
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Email address *
Date Today *
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Name (Family Name, First Name, MI) *
Age *
Gender *
Date of Scheduled Appointment *
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DD
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Office of Transaction *
Mobile Number *
Do you have any flu-like symptoms? If yes, tick all that apply. If no, tick none. *
Required
Declaration *
Required
Submit
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