Online Student Application

Questions

1.  

   Student Type * (Selection is Required)

   Undergraduate

   Graduate/Professional

   Dual-Enrolled High School

   Non-Degree Seeking

   Other (Specify Below)

   Additional Note or Comment
2.  

   Reason for Request (select all that apply)

   I have tested positive for COVID-19 and am isolating in my residence

   I am in quarantine due to COVID-19 exposure, symptom expression, or out-of-state travel requirements

   I have a medical condition that puts me at a higher risk of serious illness from COVID-19, as defined by the CDC (Specify Below)

   I have another high-risk factor, as defined by the CDC (e.g. age, obesity, pregnancy) (Specify Below)

   I live with someone with a high-risk factor or medical condition, as defined by the CDC (Specify Below)

   I care for someone with a high-risk factor or medical condition, as defined by the CDC (Specify Below)

   I am providing care for a child whose school or childcare provider is closed or unavailable due to COVID-19 (Specify Below)

   I have a medical condition or disability not included in the CDC health factors that I believe is affected by COVID-19 (Specify Below)

   My current work requires me to quarantine following out of state travel so I am unable to work after my return from campus (Specify Below)

   I have a financial hardship that will be created by coming to campus for my program (Specify Below)

   Other (Specify Below)

   Additional Note or Comment
3.  

   Will any of your Fall 2020 classes have on-campus requirements? * (Selection is Required)

   No, all of my classes will be offered fully online

   Yes, at least one of my classes is in-person, hybrid, or distance enhanced (Specify Below)

   I'm not sure

   Additional Note or Comment
4.  

   Select the option that best describes your anticipated living arrangement for the Fall 2020 semester. * (Selection is Required)

   On-campus housing

   Off-campus and within walking/commuting distance

   Living outside of commuting distance (Specify Below)

   Additional Note or Comment
5.  

   Which adjustments are you requesting to perform your academics safely? (Select all that apply)

   Academic flexibility during quarantine/isolation

   Remote attendance/participation for on-campus academic requirements

   Additional/enhanced personal protective equipment (PPE) (Specify Below)

   On-campus housing accommodations (Specify Below)

   Alternative arrangements for face covering requirement (Specify Below)

   Other (Specify Below)

   Additional Note or Comment
6. Please provide any comments or other information that may be useful in evaluating your request.
7.  

   Acknowledgement * (Selection is Required)

   I attest that the above statements are true. Falsification of this document, or of supporting documentation is grounds for referral to the Dean of Students for a Student Code of Conduct violation. I understand that my request for accommodations related to COVID-19 will alter and change the delivery of my classes and that this will be reassessed every semester.

   Additional Note or Comment