Fall 2021 Reopening Plans
We will reopen our campuses for classes, activities, and residential living in Fall 2021. Find the latest information on our Fall 2021 Plan page.

Submit this form before your scheduled campus visit

Welcome to Lesley University! We're delighted that you are visiting our campus. For your safety and the safety of our community, please complete this self-assessment form and submit it before your scheduled visit. We also ask that you follow the on-campus guidelines we've described. On behalf of all of us at Lesley, thank you!

Please do not complete this form more than 48 hours prior to your campus visit.

COVID-19 Self-Assessment Questionnaire
Student Name
Permanent Address
Permanent Address
Permanent Address State and Zip
Indicate the date of your planned campus visit
Please answer these questions honestly. If you reply "yes" to any of the questions, please contact your health provider and do not come to the Lesley University campus.
Please read this list of symptoms before answering the next question.
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
While on the Lesley University campus, I agree to:
  • Always wear an appropriate cloth face covering while on campus. Appropriate face coverings must have at least two layers of fabric. Bandanas, neck gaiters, buffs, and face masks with valves are not acceptable.
  • Maintain physical distancing of at least 6 feet if requested by your Lesley host.
  • Only enter the areas of campus for which I am approved to access.
  • Leave the campus once my scheduled visit time has ended.
  • Practice good hygiene by following all recommended protocols, including thorough handwashing, using sanitizing stations, and using appropriate sanitizing materials to clean up after myself on campus.
  • Immediately leave the campus if I start to feel sick or develop any of the symptoms described in this questionnaire while on campus.
  • Notify Lesley if I feel sick or develop any of the symptoms described in this questionnaire while on campus or soon thereafter, test positive for COVID-19 within seven days before my visit to campus, or learn that I had an exposure to someone with COVID-19 within seven days before my visit to campus.