COVID-19 REPORTING FORM – American Film Institute
COVID-19 POSITIVE TEST REPORT

COVID-19 REPORTING FORM

Address
Address
City
State/Province
Zip/Postal
Country
Gender:
Race/Ethnicity:
Test Type:
Symptom (select any that apply.):

Please provide the names of faculty, staff, or other fellows that you have been in direct contact with (i.e. within six feet for more than 15 minutes) two days prior to and any time after the onset of symptoms or a positive COVID test.

First Name
Last Name
DONATE

SIGN UP FOR OUR NEWSLETTER