Request to Return to Work or Class Following COVID-19

Name*

First Last

Email*

Phone*

Has it been at least 10 calendar days since the onset of your symptoms or since you began self-quarantine?*

Have you been fever-free (below 100.4 F) without the use of fever reducing medication for at least 24 hours?*

Are you experiencing any of the following symptoms? Check all that apply:*

Has someone in your residence (household, dorm room, or apartment) been diagnosed with or suspected to have COVID-19?*

Please provide any additional details related to your current situation.

Are you a student or employee at Milligan?*

Employee Information

Job Title

Supervisor First and Last Name