Request Form

* indicates a required field


Thank you for notifying us about your recent positive test results for COVID-19. Please know that we are here to support you during this time and hope that you have a quick recovery. As part of our contact tracing process, please respond to the below questions as quickly as possible. This is your only contact needed at this time. If you are a student FSCJ will contact your instructor and any students you may have come into contact with at FSCJ. All information is held in strict confidence according to FERPA.
Have you previously submitted this form with us before?Required
FSCJ RelationRequired
Please indicate your status at the college.
Self, Spouse, Daughter, Supervisor, Parent, etc.
Use an email address that you check regularly.
Have you received positive test results for COVID-19?Required
Have you experienced any symptoms?Required
Try to be as specific as possible about areas in addition to your classes where you might have visited.
Which campus(es) did you visit?Required
Select all that apply.
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Were you wearing a Mask/Personal Protective Equipment (PPE) during your interaction?