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 This form is for students and employees from the University of Evansville and Harlaxton College to complete.  

 
  In an effort to educate our campus community about possible exposures to the Coronavirus (COVID-19), please provide the following information regarding:

1) Any potential exposure you may have had to COVID-19
2) If you are currently waiting for COVID-19 test results
2) If you have a confirmed diagnosis for COVID-19
   
1.
 
   
2.
*
*Selecting "Yes" will bring you to a page that asks about your potential exposure and if you are awaiting COVID-19 test results.
 
   
 
 
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