Campus Visitor COVID-19 Health Screening Form (Students and Families)

Type of Visit/ Event

Date of Visit to Campus

Scheduled Arrival Time

Name of the Person You Are Meeting With

*How Many Guests Will Be With You?

Student Information:

Student First Name

Student Last Name

Student Mobile Number

Student Email Address

Student Birthdate

I Certify That:

I have not been in close contact with anyone being diagnosed with COVID-19 or placed on quarantine.

I have not been asked to self-isolate or quarantine by a medical professional or local public health official.

If I have recently returned from an identified travel hot spot, that I have self-quarantined for 14 days, I am symptom free and have not tested positive for COVID-19*

Guest #1 Information:

Guest #1 First Name

Guest #1 Last Name

Guest #1 Mobile Number

Guest #1 Email Address

I Certify That:

I have not been in close contact with anyone being diagnosed with COVID-19 or placed on quarantine.

I have not been asked to self-isolate or quarantine by a medical professional or local public health official.

If I have recently returned from an identified travel hot spot, that I have self-quarantined for 14 days, I am symptom free and have not tested positive for COVID-19*

Guest #2 Information:

Guest #2 First Name

Guest #2 Last Name

Guest #2 Mobile Number

Guest #2 Email Address

I Certify That:

I have not been in close contact with anyone being diagnosed with COVID-19 or placed on quarantine.

I have not been asked to self-isolate or quarantine by a medical professional or local public health official.

If I have recently returned from an identified travel hot spot, that I have self-quarantined for 14 days, I am symptom free and have not tested positive for COVID-19*

Guest #3 Information:

Guest #3 First Name

Guest #3 Last Name

Guest #3 Mobile Number

Guest #3 Email Address

I Certify That:

I have not been in close contact with anyone being diagnosed with COVID-19 or placed on quarantine.

I have not been asked to self-isolate or quarantine by a medical professional or local public health official.

If I have recently returned from an identified travel hot spot, that I have self-quarantined for 14 days, I am symptom free and have not tested positive for COVID-19*

Guest #4 Information:

Guest #4 First Name

Guest #4 Last Name

Guest #4 Mobile Number

Guest #4 Email Address

I Certify That:

I have not been in close contact with anyone being diagnosed with COVID-19 or placed on quarantine.

I have not been asked to self-isolate or quarantine by a medical professional or local public health official.

If I have recently returned from an identified travel hot spot, that I have self-quarantined for 14 days, I am symptom free and have not tested positive for COVID-19*

Guest #5 Information:

Guest #5 First Name

Guest #5 Last Name

Guest #5 Mobile Number

Guest #5 Email Address

I Certify That:

I have not been in close contact with anyone being diagnosed with COVID-19 or placed on quarantine.

I have not been asked to self-isolate or quarantine by a medical professional or local public health official.

If I have recently returned from an identified travel hot spot, that I have self-quarantined for 14 days, I am symptom free and have not tested positive for COVID-19*

Terms and Conditions:

I completed the Ramapo College Visitor Registration Form, and I confirm I do not have any COVID-19 symptoms.
I will locate and use hand sanitizer stations as needed.
Ramapo College has clearly communicated that individuals who are not feeling well or exhibit symptoms should stay home. However, I understand I am attending this event at my own risk.

In the event you develop any of the symptoms listed above or test positive for COVID-19 within 14 days after visiting our campus, you must contact the Human Resources Department at (201) 684-7506 or via email at jcbrown@ramapo.edu. Thank you for keeping our campus safe!

By submitting this form, my guests and I agree to abide by all guidance outlined in the Ramapo College Return to Campus Plan while at a Ramapo College location and acknowledge the risks associated with entering a Ramapo College facility related to COVID-19 and other communicable diseases.

Office of Admissions

Campus Visitor COVID-19 Health Screening Form (Students and Families)

Office of Admissions

Contact Information