Please fill out the form to the best of your ability. This form should only be utilized by those students and employees who have been ordered by a public health official to isolate as a result of a positive COVID-19 diagnosis or have been required to quarantine as a result of having been exposed to someone who is COVID-19 positive.If possible, please provide documentation of your isolation or quarantine by attaching it to this report. If you do not have documentation, please have your provider or public health official/contact tracer send it to the MATC using the preferred secure file upload method:
Secure File Upload Link
Secondary Method Email Documentation to: email@example.com
Date of this Report
1/24/2021 3:21 PM
MATC ID Number:
If you are a student or employee the College will contact you using your institutional email address
Your affiliation with the College:
Last Date on Campus:
Nature of this report:
Please identify those individuals who you believe have exposed you to COVID-19?
Please provide the name and location of the health department or testing site.
Please indicate the date in which your isolation or quarantine is to start.
Please indicate the date in which your isolation or quarantine is to end.
Please submit any electronic documentation from a public health official, Kansas Department of Public Health, or your medical provider which verifies that you are to be in COVID-19 isolation or quarantine. Where possible this should include your beginning and end isolation/quarantine dates.
I understand that if MATC does not receive documentation regarding my medical absence then I will be subject to program/classroom absence policies.
I also understand that it is my responsibility to contact each of my faculty members to discuss my absences, make arrangements for alternative instruction, and how assignments, tests, quizzes, etc. will be handled.
For the safety of the MATC community and to continue mitigating the spread of the COVID-19 virus, all students, faculty, and staff are expected to comply and cooperate with the requests of MATC COVID-19 staff in a timely manner. Students who fail to comply are subject to disciplinary action.