Nazareth College Residential Life Flu Form
Please use this form to report to the Department of Residential Life if you have flu-like symptoms.
You are also asked to contact Health Services to inform them of your symptoms.
Please be sure to email the Department of Residential Life at
reslife@naz.edu
once you are feeling better.
* Required
Name
*
Student ID Number
*
Building/ Room
*
Cell Phone Number
*
When did you get sick?
*
What are your plans?
*
I am going home until I get better
I will isolate myself in my room until I get better
Other:
If isolating yourself in your own room, do you require meals to be delivered to you?
*
You should not be going to the Dining Hall while you are sick. These meals will be paid for through your meal plan. (Dependent on meal plan type)
Yes
No
Yes and I have special dietary requirements (please write in other)
Other: