Student Flu-Like Illness Tracking Form

It is necessary for Arizona Western College Health Services to track Flu-Like illness at all Campus and Learning Center locations to determine if our prevention strategies are adequate in minimizing infections.

Furthermore, it is important to provide the Yuma County Health Department, La Paz County Health department and the State of Arizona Health Department with all the necessary statistics on the epidemiological nature of the Flu virus. All information provided will remain as confidential as possible, while tracking this virus.

If you are experiencing symptoms of flu, please check the appropriate box(es) below:

1. Enter your full name

2. Enter your age:

3. Enter your gender:

   Male   Female

4. I am experiencing the following Flu like symptoms:

   Fever equal to or greater than 100 degrees Fahrenheit
   Cough
   Sore Throat

5. Date flu-like symptoms began:

6. I am a student living "On Campus" at:

   Garces Hall
   De Anza Hall
   Kino Hall
   
   

7. I attend classes at the following AWC or NAU-Yuma locations(s):

   Web Student Only
   Yuma Main Campus
   Entrepreneurial Center
   Construction Trades Center
   Martin Luther King Jr. Neighborhood Center
   San Luis Learning Center
   Somerton Learning Center
   Parker Learning Center
   Quartzsite Learning Center
   Wellton Learning Center