COVID-19 Self-Reporting Form

Please complete the form below if you or the person you are reporting for is experiencing COVID-19 symptoms as described by the CDC. The information is confidential, shared only on a need-to-know basis, and will be used to monitor COVID-19 activity at WNCC.

John Doe
(308) 555-5555
Which best describes you?
WNCC Campus
Reason for Self-Reporting*
Have you notified the Office of Student Life (for students) or your supervisor (for employees)?
Students: Do you live on or off campus?
Students: Are you a dual-credit student?