Graduate Student Health Survey (COVID-19)
Please complete the below survey to provide the Office of the Dean of Graduate and Postdoctoral Studies with information about your health concerns and needs and upcoming travel plans. The questions contained in this survey are optional.

The responses will remain private within the university to administrative officials who are in a need to know position.
Student ID: *
Name: *
Graduate Program: *
Rice Email: *
1. What is your Spring 2020 housing status?
Clear selection
2. Do you have a condition that affects your immune system?
Clear selection
3. If yes, please elaborate.
4. Do you have any underlying illness or take any medications that place you at risk for complications when ill?
Clear selection
5. If yes, please elaborate.
6. Do you have a history of asthma or other chronic respiratory complications?
Clear selection
7. Is there any other health information you wish to share?
15. Are there any special need(s) related to COVID-19 that we should know about?
Never submit passwords through Google Forms.
This form was created inside of Rice University. Report Abuse