Student Illness Form Student Illness Form Student Name* First Last Level*High School/SecondaryAdult EducationCampus*Practical NursingWillow StreetMount JoyBrownstownNew ChoicesInstructor Name* Phone*Student Email* Symptoms* Select All Fever or chills Cough Shortness of breath or difficulty breathing Fatigue Muscle or body aches Headache New loss of taste or smell Congestion or runny nose Sore throat Have you been to a doctor recently and have been tested for COVID-19, flu, or any other communicable diseases? Have you been around anyone that has COVID-19, flu, or any other communicable diseases within the last fourteen days? Have you tested positive for COVID-19, flu, or any other communicable diseases within the last fourteen days? Have you traveled outside the country within the last fourteen days? Δ
