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Contact Information
First Name
Last Name
Phone
Email Address
JAC Number
What testing week are you submitting a response to?
-- Select --
Week 1 (8/29 - 9/4)
Week 2 (8/29 - 9/5)
Week 3 (9/12 - 9/18)
Week 4 (9/19 - 9/25)
Week 5 (9/26 - 10/2)
Week 6 (10/3 - 10/9)
Week 7 (10/10 - 10/16)
Week 8 (No Testing Requirements)
Week 9 (10/24 - 10/30)
Week 10 (10/31 - 11/6)
Week 11 (11/7 - 11/13)
Week 12 (11/14 - 11-20)
Week 13 (11/29 - 12/4)
Week 14 (12/5 - 12/11)
What repercussion are you requesting to be reversed?
Please note, if a test was missed (testing did not occur in the week Sunday - Saturday) or an exemption form was not submitted in the selected week above, fines cannot be reversed.
Fine
JACard Deactivation
Withdrawal Notice
Reason to reverse repercussion
There was a mistake, I did complete testing in the week chosen above
I missed a test in the week chosen above, however I completed a test (on or off campus) afterwards to reverse a repercussion (this does not include fines)
I missed a test and need to complete an exemption option. Please note that this exemption will be reviewed by the COVID-19 testing team and may not be accepted
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