Request for Exemption from Mandatory Precautionary Quarantine- Spring 2021

Name Name * First Middle Last
Student ID Number ("A" Number) *
Email *
Phone Phone - ### - ### ####
Please select the option that best describes your reason for requesting exemption from the mandatory precautionary quarantine for all SUNY students attending on-campus classes in Spring 2021 semester. *

Please select the option that best describes your reason for requesting exemption from the mandatory precautionary quarantine for all SUNY students attending on-campus classes in Spring 2021 semester. I am a Health Professions Student AND classified as an "essential worker." I need to work during the precautionary quarantine period. When not working, I understand that I am expected to quarantine from others. I understand that I must submit documentation of the COVID-19 safety protocols of my employer below. I understand the name of my employer and the specific safety measures must be on the documentation. I have documentation of a positive diagnostic result for COVID-19 on November 1, 2020 or later. I understand I must submit my test results to the Wellness Center on their webpage: https://machform.sunyorange.edu/view.php?id=553980
Upload documentation of COVID-19 safety protocols at your employer here:

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