Please use this form to report if you experience symptoms or are diagnosed with a contagious, infectious disease, as early as possible.

DO NOT visit the gwun until you have been notified by us that you are cleared to attend class.

*
Preferred Name Surname
Diagnosis*
Please select the type of diagnosis
Symptoms*
Please select if the symptoms you are experiencing could be mistaken for the symptoms of another disease
Disease*
Please select the disease
Please Describe
Please Describe
Date First Symptoms*

Day
Month
Year
Comments
Comments
Your Cell Phone:*
Please check you cell phone for any notification from WTA, before visiting the gwun next time. Thank you.
Please select if you are submitting this form as practice
- I am submitting this form as practice.

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Notification of Risk of Exposure