Commencement COVID-19 Health Check

Please submit this form prior to attending Commencement.

* Required items.

Full Name * Please enter your name. Email * Please enter an email. Invalid email. Phone * Please enter a phone number. Address * Please enter an address.

Is your temperature 100 degrees Fahrenheit or higher? * Please select an item.

Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or has had symptoms of COVID-19? * Please select an item.

Have you tested positive for COVID-19 in the past 14 days? * Please select an item.

Have you experienced any new or worsening symptoms of COVID-19 in the past 14 days? *

Cough
Shortness of breath
Troubled breathing
Fever
Chills
Muscle Pain
Headache
Sore Throat
Loss of taste and/or smell

Please select an item.

Have you travelled outside New York State in the last 10 days? *

Contiguous states = Pennsylvania, New Jersey, Connecticut, Massachusetts, Vermont

Please select an item.

Leave this field blank

Special Events Coordinator
Phone: 315-386-7870
specialevents@canton.edu