COVID-19 Self Report Form
To ensure that we can provide support/resources to faculty, staff, and students who have been potentially exposed to or tested positive for COVID-19, we request that individuals (or a designee) complete the below form. This information will also assist ABAC and public health officials with monitoring the incidence of cases occurring in our communities.

We are committed to ensuring that your submission remains confidential in accordance with applicable law and will only be used to provide support and resources. If an individual is diagnosed with a confirmed case, our public health partners will work to make sure those who have been exposed are contacted.
  • - -
  • / /
  • / /
  • / /
  • / /