LCCW Student Entrance Screening Questionnaire
This Screening is being used for campus safety.

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Email *
First Name *
Last Name *
In the past 14 days, have you experienced any cold or flu-like symptoms including: fever of 100.4° or greater, headache, dry cough, extreme fatigue,diarrhea or vomiting, shortness of breath or body aches? *
In the past 14 days, has anyone in your family or with whom you reside experienced any cold or flu-like symptoms including: fever of 100.4° or greater,headache, dry cough, extreme fatigue, diarrhea or vomiting, shortness of breath or body aches? *
In the past 14 days, have you been exposed to any other person who was known then or has since experienced any cold or flu-like symptoms including: fever of 100.4° or greater, headache, dry cough, extreme fatigue, diarrhea or vomiting,shortness of breath or body aches? *
In the last 14 days, have you been exposed to anyone who has tested positive for COVID-19? *
Have you been in close contact (family members, friends, co-workers, etc) with anyone who has traveled outside the country? *
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