COVID Self-Report Form
Please complete the following form.

A member of the Campus Safety Team will be contacting you to discuss the next steps and answer questions you may have about resources available to you.

Please remain quarantined at your residence until instructed otherwise by the Campus Safety Team.

Our goal is to ensure you are well so that you may return to normal day to day activities at RMC as quickly as possible.

If it is after business hours AND you are an on-campus student, please contact the Emergency On-Call Residence Life Staff at 406.238.SAFE.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Cell Phone Number *
Status *
RMC Employment *
If Student Lives On-Campus which Residence Hall
Clear selection
I am currently fully vaccinated for COVID-19 *
My current vaccination status is *
Stauts *
Date of Positive Test or Last Contact with COVID-19 Positive Case *
MM
/
DD
/
YYYY
I am *
Hospitalized *
I am required by a medical professional to quarantine *
If ordered by a medical professional to quarantine - date provided to end required quarantine
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rocky Mountain College. Report Abuse