Colby Visitor Questionnaire
As Colby continues to address the COVID-19 pandemic, all non-essential campus visitors including faculty, staff, and student guests will be limited to the maximum extent possible, and whenever feasible all in-person visits must be rescheduled or conducted virtually.

Visitors essential to the continued operations at Colby must be approved by the College before coming to campus. To complete the approval process, all potential visitors must complete this questionnaire. Upon completing this form, all information will be reviewed and disseminated for final approval by the Vice President or Dean responsible for the visit. No visitors should travel to Colby until completing this process and getting permission from the College.

Please review the visitor guidance located at Colby’s COVID-19 Information and Resources webpage or contact Wade Behnke at 207-859-5504.
1. What is your legal name? *
Your answer
2. What is your primary phone number? *
Your answer
3. What is your reason for visiting? *
4. What is the nature of your visit and who is your primary contact at Colby? *
Your answer
5. What date are you scheduled to arrive? *
MM
/
DD
/
YYYY
6. What date are you scheduled to depart? *
MM
/
DD
/
YYYY
7. Over the course of the last 14 days, which countries, cities and states have you stayed in overnight or visited? *
Your answer
8. In the last 14 days have you had any flu-like symptoms, including: fever, sore throat, cough, difficulty breathing or shortness of breath? *
9. In the last 14 days, were you unable to maintain social distance (6 feet radius) from anyone with flu-like symptoms or anyone diagnosed with COVID-19? *
10. In the last 14 days have you attended a gathering where a participant had or was later diagnosed with COVID-19? *
11. Where will you be staying while you are visiting Colby? What are your lodging arrangements? *
Your answer
12. Is there anything else we should know about your visit?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Colby Apps. Report Abuse