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Coronavirus Self Assessment Form

Please include Area Code
By submitting I hereby confirm that the information I have given above is true, and that I will comply with the terms and conditions outlined above.
MM/DD/YY

Data collection, management and disclosure: Personal information collected by CityU is under the authority of sections 26(a), (c), (e) of the Freedom of Information and Protection of Privacy Act, the Public Health Act and the Canada Quarantine Act, for the purposes of compliance with those acts by the university and to reduce the spread of COVID-19. CityU may disclose personal information as required by law and to personnel who will provide students and staff with support services and who will follow-up with idviduals during self-isolation.