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COVID-19 Self-Reporting Form

WHO SHOULD COMPLETE THIS FORM?

To ensure that Northern Oklahoma College can provide support and resources to students and employees, the College is requesting that the COVID-19 Self-Reporting Form be submitted by an individual when:

  • You have received a positive COVID-19 test result

Students are required to immediately self-report to the appropriate campus administrator a positive COVID-19 test.

Employees are required to immediately self-report to the appropriate campus administrator, as well as notifying their immediate supervisor.

CAMPUS CONTACTS:

  • Enid Campus: Jeremy Hise, Vice President for NOC Enid, 580.548.2393
  • Stillwater Campus: Wade Watkins, Interim Vice President for NOC Stillwater, 580.628.6905
  • Tonkawa Campus: Jason Johnson, Vice President for Student Affairs, 580.628.6272
  • Human Resources: Shannon Cranford, Director of HR, 580.628.6229

WHAT DOES THIS FORM DO?

This form is how you will notify appropriate campus administrators on the emergency response team and Human Resources about your condition. It will create an email confirmation of the report for illness.

WHAT HAPPENS NEXT?

Individuals completing this self-reporting form will be contacted by a campus administrator (see campus contacts).

QUESTIONS?

If you have any questions about self-reporting or concerns or do not have access to a computer to complete the self-reporting form electronically, please contact Jason Johnson, Vice President for Student Affairs, at 580.628.6272 or jason.johnson@noc.edu.

Please complete this electronic form and submit. 

NOC COVID-19 Self-Reporting Form

If you don't fill out the required fields the form will not be submitted!

  • MM slash DD slash YYYY

  • If you tested positive, fill out this section:

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • By submitting this form, I am granting permission to be contacted via phone or email by campus administration concerning the information provided.
  • This field is for validation purposes and should be left unchanged.