90-Days from a Positive Test for COVID-19 ATTESTATION FORM Section 1. Purpose of Form In the event that a USC student should need to verify exemption from testing due to a previous COVID19 infection, this self-attestation form may be provided as documentation of the correct dates.
Section 2. Statement of Dates for 90-Day Period Exemption from Testing Student Name: __________________________________ USC Student ID: _________________________________ Program requiring attestation of date:______________________________________________________ Complete ONLY ONE of the following dates: Date of onset of symptoms (if symptoms were present): ___________________; OR Date of test (if no symptoms were experienced): ____________________. The date listed above is considered “Day zero.” Calculate 90 days forward; you may use an online calculator for convenience: https://sbcovid19.com/quarantine-and-isolation-calculator/ The last date of the 90-day exemption from COVID-19 testing is: _________________.
I certify that the above facts are true, to the best of my knowledge and belief, and I understand that I subject myself to disciplinary action in the event the above facts are found to be falsified.
Student Signature: __________________________________ Today’s Date: ______________________
Form updated 02/15/2022