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Ebola - Holiday Travel Form

 
 
 
The University of South Alabama is committed to providing a safe environment for our students, faculty, and staff. Currently USA is following the Centers for Disease Control and Prevention (CDC) travel screening guidelines for Ebola.
Please answer the following question:
1. Are you planning to travel to Africa during the upcoming holiday season?
  Yes         No
If you have answered No to question 1; stop here
Please complete the remaining fields, if you are planning to travel to Guinea, Sierra Leone, Liberia and Mali during the holidays.
Name  *
J Number (i.e. J00XXXXXX)  *
Email Address
Phone Number  *
Local Address  *
Planned Date of Return to the United States  *
 
Form 0016