Precautionary Quarantine Attestation- Spring 2021

PLEASE READ BEFORE COMPLETING THIS FORM. Your precautionary quarantine period must be completed BEFORE submitting this attestation form. Students who submit this form before their precautionary quarantine period will need to resubmit the attestation after the precautionary quarantine period is completed.

All SUNY Orange students are required to complete this form if they have not been previously granted an exemption.

Name Name * First Middle Last
Student ID Number ("A" Number) *
Email *
Phone Phone - ### - ### ####
My classes start the week of: *

My classes start the week of: January 25th AND I completed the precautionary quarantine January 18 to January24 February 1st AND I completed the precautionary quarantine January 25 to January 31
By my signature below, I affirm that I have completed a seven (7) day Precautionary Quarantine as required by SUNY for all students who will be attending on-campus classes in the Spring 2021 semester. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.