COVID-19 Self-reporting Travel Form

The health and wellness of the Kentucky State University campus community is a top priority. As we take the necessary precautions to protect all members of our community during COVID-19 virus pandemic, it is imperative that members of our campus community report all recent travel.

Faculty, staff and students who plan to remain in the local community and any student who requests to reside on campus should:

  1. Review both abroad travel CDC Level 2 and Level 3 locations (international map) and states in the United States (U.S. map) with widespread  COVID-19 presence.
  2. If you have traveled to any of these locations or have been on a cruise in the last 14 days, please complete this Travel Reporting Form. If you do not meet these conditions, do not fill out the form.


If you are a student and you believe you have been exposed to a known or suspected case of COVID-19 while traveling, please call Health Services (502)597-6271 or your primary health care provider. Seek medical attention if you experience fever, cough or difficulty breathing. It is recommended that those who think they may have been exposed call ahead before going to Health Services, their primary care physician or an emergency room.

This self-reporting travel form will also allow Kentucky State to send important instructions for monitoring during your 14-day self-isolation. Please follow any directions noted and complete any surveys emailed to you during the course of your monitoring period to avoid unnecessary calls from Health Services.


If you are an employee, you should call your local health department or your primary health care provider.

If we have questions or need to speak with you regarding the results of your self-reporting travel form, Kentucky State will contact you at the phone number provided, so please ensure the number listed is your preferred method of contact.

Have you traveled to a country that has a current CDC level 3 health notice?*
Have you traveled to a country to a U.S. state with widespread presence or been on a cruise?*
Have you been exposed to a known or suspected case of novel coronavirus?*