COVID-19 Return to campus form

CLICK HERE FOR PRINT VERSION.

  • Person Self-Certification

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • By signing this online form, I verify that I have been symptom free for the appropriate number of days and that the information reported above is correct. Therefore, I can be released from isolation and may resume school-related activities.
  • * This form is not required by the State of Louisiana to return to school but is intended as a guide to assist Nicholls State University personnel on when it is safe to return to school. This form is not mandated by the State of Louisiana.

    **The test must be a negative PCR test at least five days after exposure to a positive cxase or suspected illness.

    Please call University Health Sevices at 985-493-2601 is you have any questions.