COVID19 Self Report Form

COVID-19 Self Report Form: South Georgia State College

To ensure that we can provide support/resources to students who have been potentially exposed to or tested positive for COVID-19, we request that individuals (or a designee) complete the below form. This information will also assist SGSC and public health officials with monitoring the incidence of cases occurring in our communities.

We are committed to ensuring that your submission remains confidential in accordance with applicable law and will only be used to provide support and resources.  If an individual is diagnosed with a confirmed case, our public health partners will work to make sure those who have been exposed are contacted.  

What does to be fully vaccinated mean?  In general, people are considered fully vaccinated:

  • 2 weeks after their 2nd dose in a 2-dose series, such as the Pfizer or Moderna vaccines
  • 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine

Please fill out the form below. Required fields are indicated with a * symbol. Thank you.

Personal Information

First Name
Last Name
Are you a Commuter Student?
Are you a Residential Student?
Are you fully vaccinated?
Write in the date or unknown
Write in the date or no symptoms
Write in date or not applicable
Write in the testing site or not applicable: