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COVID-19 Infection Report for Students

This form is to inform the Institute that you have tested positive(with/without symptoms).

・Fill in all fields marked with  an asterisk (*).

・Click the "Resume later" button in the upper right corner of the screen to temporarily save the form.

For any inquiries, contact pcrteststudent@jim.titech.ac.jp


There are 17 questions in this survey.