Arizona Serve COVID-19 Self-Report Form
This form will provide a mechanism for us to collect information from members and sites who have either been exposed to or received a positive test of the Corona Virus.
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Email *
Date *
Name *
Region *
Affiliation *
Site *
Please detail you or your site's exposure.  (Include: Symptoms, your ability to self-quaratine, your desire and need to get tested.)
Please retrace you or your site's contact with others.  (Include: Dates at the site, the Arizona Serve office, and contact with other AmeriCorps members)
Do you have the ability to contact those you have been in touch with?
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What resources can Arizona Serve ensure you have access to during this time?  
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