COVID-19 Travel, Exposure, and Diagnosis Disclosure Form

Please complete this form if:
You have travelled internationally, or to NY, NJ, MA, CA, Fairfield County CT, or to any location designated as a COVID-19 "hot spot", since February 1, 2020 OR You have upcoming international travel.

In accordance with Goodwin University's new COVID-19 Travel and Exposure Disclosure Policy all members of the Goodwin community, including students, faculty, staff and campus-based third-party vendors, must complete this form as soon as practicably possible. For more information on this policy, and what's being done to keep the Goodwin community safe, visit the webpage.

Your information will be protected, and will only be shared on an as-needed basis.

Your Information
Travel #1
Type of Travel  
Travel #2
Type of Travel  
Travel #3
Type of Travel