ࡱ>  Root EntryWFileHeaderHDocInfo HwpSummaryInformation.@TVUXYZ]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntryFileHeaderHDocInfo HwpSummaryInformation.@ Q !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPR CONFIRMATION <Student ID No.><><Program & Major><><> <Name><><Contact No.><><> <><><><><> <v' If you have the following symptom(s) in the last 7 days, please tick the relevant box(es)> < % NO> < % YES><% Fever (37.5! or more) % Cough % Phlegm % Sore throat % Shortness of breath> <w' Have you visited overseas, any areas or facilities occurs COVID-19 infection in the last 14 days?> < % NO><> < % YES><% country/place : ( ) % When : 20 . . . to 20 . . .> <x' Among people who live with (family, roommates, housemates etc), Is there person who have been to overseas in the last 14 days?> < % NO><> < % YES ><% Relationship: ( ) % Region/City: ( ) % When : 20 . . . to 20 . . .> <y' Have you been in contact with a confirmed COVID-19 patient in the last 14 days?> < % NO><% YES> <I here by certify that the above information is true and correct. I understand that any falsification or omission of any facts will lead to civil >W=K@~sZZLqo, :9ZTա:[PACpA.] n*R%m>I9$w $ Igc`,(Vz vيcŞ7i[ T.Z7dRE.PÁMx48 It:ҵE6yX-s괉l}Hס x;=zˆfFe؀(*,d yS>9NϦI 46ƻ?hPH+na\6zݜG@ WK%EzI]Jot 8&{X&Ij] !@ۀ¬K6hQuY6hPtui(a]}ږ-$.O ЦW֥Ӷh[¥JW;%s{HrŜ^ҍoct~8}9c8w?ag6-kBԆC[CtYY17;h7?|&e4#!ώi; wIz 3ǠJ];Oj9{gӃ1}5TNp;p ]Ft둡.9Z& 3eO #tѬCELF}sYUzXkaߩ+ӹ̊-`s?1iSNoo0ͣ|iN2n6kMs&Tz 2LwAGɍ1ڞ9Ad6\Ukr t?oᯃgkA/&o~0 f>q.踋uĺ_7m01=?G0YOXy6 &,>3o6ڬZߋ㛡bҳ8ղ<*mq m @|;d@n'7IZ^"1Bv`$1p56B m&S`t7c-ЃtЁIp`3kXn]U+5qa]XP4,`̀;âkCXʚ}ەJL^RC%e%=?VL^Qb%fT33%.+2P f =hUb-+RΜ#"D$K@V@ ""! `hxDBxHD3sVrmV{kE+g`=ZS\!z ^⤲"|Qtm XVU;j ~Z}X"~[gp'!o΃`b zqp`dq8m\MX|`a``a`0x  d p | } ajou2020D 4 8| ”| $ 3:57:03ajou 11, 0, 0, 3156 WIN32LEWindows_8@P |r @p1@HWP Document Filec`@nncd߈ .> <y' Have you been in contact with a confirmed COVID-19 patient in the last 14 days?> < % NO><% YES> <I here by certify that the above information is true and correct. I understand that any falsification or omission of any facts will lead to civil >WMh\U>7̤IIֈ}Ub"R("i6Sۤ5&L֤S2i.FН AqQpхݹ, n UQw}?{3d d{9wwB<أDUͿ|N4CZR_Li ~7mgx>,=9L{o0ErGC()BwKMYth[cOJkAkHm cVfhfFa{9y'K*Qra=V2PY#ӟ~25g8Q]~G>Y'\P ;CunQA3ϊaɣ DOœNpJSPnyZkT]]yt(k:0Ћ~iߍ1M8F@zc DEhÂ.<SGSN ~{, gT&u2 a33OF#ɶ d\km?b_~{x⿷em_FվFmqBr︜ y#ᩯu9B% B%B%†Y嶜KqYE)1e{JkUD&]x2` =]ADBx/=;͓HՆN@ȗце!_N"GBr|9J6@cAxπ5q"KyQ?6PYԐr]B :]K05O1<˭{+ԐJtV Ϙ-Bqw ?Z3UF܌84h D5}~FKnQIb oY/ΛLy-3Tdr*3Y5)Bo3UI&^1IX007P3{a%!?hꇐ*ܧ"?$sk(2MUUiF?/bbok8S5(kA㔧ݒV_9j)/!`RLB6"Y[nBIl-=D{c`Pe``bW& pAYr /8gH`2 BodyText `{pPrvImagetPrvTextDocOptions PNG  IHDRRsRGBgAMA a pHYsodsIDATx^ё+P?٢o! deJ .;'F@dh;vOs \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j`ݿ/OO)_~S[k?[_oY}/?)2oｖg{^>=/k[\7~O{߽  5߿Cڥ0_ZgB_]_/=bzpQ]%okᒶ?. s/]?e"9ۏq ^d~/k|E5껱^^Zk&½e6>ۿ)/$.AYsиPS[|3/wda#bt zi.E3\W^o&5h\G.\0o~'2zeKŵs"?5Ks/ۓw*iE9?yV @B }W'\fk-\ .??јCyx?4.@h%=_\{k`W{kC^dw_s^R~u{ˆWƅ_z5'S:Z^Te͙\. _ǾG]_0V }nj`R.wsck&Ko:w~pǏPNk4.#u4瑵~5-]T Z+P8|}ghr9ُY @B L_o" ao_M.Zu?/Fk =u6";^'\K닗B7 rOQsиPKԯ#?.>ʯ~.Ez~Q  u<1/y}->{ƅXo_eJR^Tk:l/Yu?Kʼݵwnj`YKF_?\J/LFY~[o-0\N_c_Úsz75ٿN\j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p.ON8 n%;' -d>_PSx̧ | TxC6^qήGw󎿃w{d>z5x:z7W٭Q?ḑ̾جndziv׋Zw0ۜ=2 O%jzz}X߫Ǝ*n6g6wekc_3;ןZ3wxs“|^}ǚ>ľ8Wνu`w;>jܳ?n;᳧ڇ=չl^^ѳͩگ>O>p83sj;Ս4³ç‹ۇY;V;en47>5<8r𬚨7z3+sG#;]`oW7[;ڇjһ>aV۱z5}}Ts{}zw9ۇjһ>}dy,cf6ۇQMuq^̮Gw󎿃տY]լjzM~w=9|*p mw~: ܂/(w)O@S[> |*p >On;' -d>_PSx̧ | T|AO}2 ܂/(w)O@S[> |*p >O紥>GߴSC/aM'Fx;6o47FcQcj^.|*|їDnVjgţ#kf6^/?+>O F݌ί +gD| ]ky(GTL^<>>=>v3꿋;6旯;+ҏ(ǧ‡Q]|ߴ|ܳѳ津3˿T/Q6꿋;6旯;}>*ⱷ4ҹL^<>>DK^;|Ah_5b;fU{W| bpcyz+|A\hir{f6״,l0W| ?w|;~N5' -d>_PSx̧ | T|AO}2 SDDDDNv[G > |*p >On;' -d>_PSx̧ | T|AO}2 7q|@>Gߍ/(}|ңݿ_q>Ԣ}!^Ǩ3ʲmʲgs²Ѵ/ʆ*χ#ԫ;<; >Ԣ}!/Ǻ>ĺʪب|һ7/ʬٳ3g՛۲Ѭ?꙰߃èӲ炻;;͵&v36ôͣ}Ta?ľj}^m7G=kp7ωM>wz=wn[zf5+}=iFl,ƱGߛOn;x7jY|*p >On;' -d>_PSx̧ | T|AO}2 ܂/(w)O@S[> |*Nc8 .p \j.p \j.p \j.p \j.p \j.p \j.p \j.p.OAp.?PBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](\ڜ^&+w6Eιϸp.v{亝]^K|xMm͕uc꜕ṳ+(Bմ9h״fݙ{+ҳʞg?3ҥٍG=\㣯y#OWƲ6ߛ7sNfڹUc9xTX/fY}7g77Fɵ~46jρ u:ƌ⼘<^շgsZٜج=o^bM_+wbƫYfVF[r_lƪqR۽Ě\۽Tsb{66JduNiz}:e6ge,Uy,yqǹQr]l?2gXρ u:ƌ⼘<^շgsZ9Umk[XWf㝱n}jlY]-/gcU{TGbM^9=eVVV:'UxmhFk1qle6'Ŵx/>]ڱ?>XuϰձƲ;ǹc9r<.ԥ03bxUj8gcTsZ;Gsy9&rZ(n^y{v{j{5q^5[N}m}1Qn=Vfs^rMl籘66%繽V;Js{Ռh?Fu=jrF㽹9Ruہy1yiqN|۳Qfsfc/ǫ͟&ϛWU]&ϋkg{=ڣǽv/Wyl%fuG۹?*y^lY(yNl籘66ɉyll5yh?iin%l,c|b(vgρ ui0C۫䚕91؞23rXWf^=cfc17=ε1yqjQfsrjNlF5ѱ*;vllVw2:2:6K5c|k(._1S^yp.vx{y-ַ2srͨ{sb_o\ڹ^m\#h,^{xgJǾ^mN/DZ^mc=JsrVQ;ܘXoNeH\77~$GujXkX8KxQm럥Whc&%9mX׫y,+s<.ԥpLYy=ggHV+_O+{[/\=>sB]zPBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](PB} vPO?O?مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt Wc희jG5Nvʃn7и+BegY}۩hNvʃ#9eݝ~'PxAY޼j](8(}I'PpPܓNv~駟~駟?;PpPܓNvN.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN5wݿuyopO6OvpRU1bZgKYћҌ<ka6ǼƳ\Xӫk}yc_O5n;gubM싹8?c>j\c;x:.b,6U&1Zgd}-}Տz4zYFUuG;v*;Yqxܫ5QnzuWz߁](8(Q8کL5o>oWVky{+}cvyE.^Qv^3jsJqȺ^j߮g؅]g׎jrƨffgNUG֋c۫_=O[Uv^+jguqlTZvk{z}?z+u}w`  4;o;gٵG(Ѭ49G{qvW7{8֛7JϨ켞Wب5_m絼veQnVVv=c.b,>?;Ȳ9fֿ:|ڕ==YЫ[5Pʳٲ9Ϯ}<?:kyvW7{83/۩}WY}:_i絼veF+hվ]X; 9ՍǾѼ֯7]y =+awݕ5={y+pfbM0 ;+{kzsf봴vԛڷk|vNvdnsTc5f*Wk4չ=uZ~Uƣ5(֌Wydj.jU7wo3BAIkaGo}q>NvʃrUUmkU\g_8#'PxAYm;]d <(W/3ؿnu1g?$Nvʃ##ϩ#<7#BegG^GSgy~g>ﭓ](B}{.^yPv־:Fs]w0f_$Nvʃ1{w{.p Wgnܟ:م+W^hꚳ+ l'PxAYͽW^}O{d <(;yhn^?'.y:م]gq'W#]ͮj#kzsh{'5,{y w{n{w;mfv^ի}ثwN?;Qe>6c_mwÞ3O? .ivvjG}Lz/9qnǚ\Xkblv^+j[3i}.y,DZ^M5jF#n6/D/7q<׍ݫ?ޕܿR<%7Hf>ᎾϢQյ?=;م]g۸αͪ'1ʰly:5kF53՜5yY}ʲ/޳(8(gƱ+ܳ5j!ֻ86[9쮳ܳݩժy;^}ʲ/޳(8(Y=GFϽ#ϳ](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.>](8('u 㠈H?PGDDDDR\OvB-"""ҏ .Psbz5""""㞃 uiB/ѽ戈|j .ԥՋ<w\K+ޅyԎ}""""^ ui/ʭ=oU5վQhhߝ,>ΏU͙Tx8>>=QjjƳ2,g=$zj췾6եڱoG+[R͝g=QNJr.ɥ=ڳ,6Y=Džbڳ1nܖ<>ڻʳ=h쏏sر6Œ㱫Nuvjsv>ܽ;6$l7sҳܹγ}ĺb1ΙU˳ڰ=o˳ؑ8άkV?Nl,'*Fwڪ3;dz;1ܿݲdޣܰ1#K5w6>덷xTV:n/&d6??ɵwe,{VkFy^nj[};jQ\K+)'GJ~Q 8w""Y uɗH?.'PpDžd .HDD$}i9~\K<;.'PpDžd .""""PBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd _}>uڲ1&ַ<ϒ{W_u ]ՏT+:%9"""?KT\K_}^JFq,yn?[mGmyo1ټ8s<W_E0>sxUKoNˉ5G۹?Ņx9wyl%՜5sn{oFDDDnŅ՗|lxUw;TGx/"""nŅv CDD>q>م H?.'PpDžd .""""PBZDDD](⧟~駟~g.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.>](kdUU;Ukw>ﭓ](쬽[;4 'PxAY{vVvjy- 'u W͉+<7pG8م+ڏUss:م+ڏUs?w](}v^Yw繹^I|oBegoxd;.^yPv־ZFGvk5.^yPv~Fm㳵w'Beggc>^˞I|oBX{'fجq_8م;9o|['PpPܓNvN.>](8('u =d  I|oBAsO:م;9o|['PpPܓNv~駟~駟?;PpPܓNvN.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.ƙg>qw.i5-+~5> g;~qg.89ճGnw}㮜͓](8(y;jFn;=ޝ>y߸+gd  ws*WTk6,ϖ޼n6bwޣ=x#d  rގ͉}ayGsxZ7~5Fk?;qG.8YQبnP+k=:0v>z}^9'PpPxvԬfGU?cݚCnZ4jU^qG.8UQ͛DZQn͡j79l^ikJ^qG.i5\Q͟DZQn͡jGmlujl?2_γ㎜˓](8(q&sZg6Fu5XRfszU潼oܕy wZ9oGM˳֌}aTSskvꏱ7ZTkw<}㮜͓](8(ͫ~LVz56>z5zj'֟jU\\Μϓ](kdUUڽd8彫gkg3x;gd <(;k?_]sg>q9/u>KOvʃ5gu9 'u WyyNyd <(;k?:=>I|oB67g6| Nvʃ1Ǽ+1 'u Wܫ+?w](}u>w{'.^yPv־:FsWל]y]gs8م+W^h賧|['PxA9ɣFs9Y5\NvN+͙.|'BAn3Lg:~ϖ+߻R,BAV[2y:UWjzߜ1>sx 9(WWWٞzVe3'sOvN+ᵳ&gUnou*gd  rގ*Wy?Q8u.gW<|x<مgrgh,juV֯|kl=?u.gd  rގg_]y;9[_ykl=]YkTpOvp7Ǚlyڽj:环Zy;ڮzŚW5>BAV;9z1Q0zs3j+W^W~[;?K^?&=ëֽ⎯pnd  @{.y:مt wr$Nv'BA᝜7>ﭓ](8(}I'PpPx' O{d  @{.y:مt wr$Nvp?~駟~駟~v~B]jFDDDD~](PB} _?_?~Džd kzk.kb\qt_/we|]gj9_-3NޑB]>e8]dzG]iϯ%W3瑵uɷɴ}ޯ8P῱ž?]ykIʲяgw='ݵ߃^<9.ԥѿ˟a_ӟߏ [/%ujgcTs5G?Ksx&қڹ\7j2osGuqJh>(՜nϻ53j56=ǽjJX=ʼ֗ӛ3z\z5j[X=ǹvQlk{YVn=ε9yW;['2S86j\qp.~/(.wJ}z59;;yպ|֞?~M9N^LB]/___׾ngDžd y~\Ov |"""JHd5…FDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](B}<ϕ'bo~5=W+οV/XswY}Y/y4ąydWޯ;߯gFWU]I^'hs u]`òs/gsF*yN7f86Ks.JبeeNCs u]`2>{Xnjg[Y,ռ^{ydlڽTsfGfuyNnRG?{,.^bMmkrcUF4Kج=|u u]b3>^M3k?:k2Xάv66K5WjF^vı\ڣ3k?:6Ksr{jި==cYfkv/&{ıպc_o|\;[նveNrO\K Guv{3Gus=jv/՜֎ꏴ9Q;gu,ڣĺ<'GYXkg-X%yKvN%yXo*%׎1m7>˙!ąه%y,&ᲵDzڳҾ]ձ/9؎j36uⱷԏ2ű8ܱĺ<'{5j$s;&zշXKX/rһ>i|kR͉GzQZ]Lgc;VڽF}Ujά,.QVUu=zYb]۽Ě\%GǪT;؞\U]rO\K Gɵyި=oY,Um\/v6Vr_o\7j{sX/7g6>ڣVۭo%+zcqNsXK5oXv/&&X/.΍派YڝؑќXkzc"wq>q. {,DDδCsk\K>EDDDq>م H?.'PpDžd .""""PB?O?O??vv'BA᝜7>ﭓ](8(}I'PpPx' O{d  @{.y:مt wr$Nv'BX{'x|j ^þI|oBegY}olqW8م+ڻﭓ](HhN_Yw;.^yPv~7vk5.^yPv~7vy#Beg+ʺ;5O{d <(;k_}#; <Nvʃ7z<\c$Nvʃ3j[=d <(;k?덯ZO{d <(;Y5f5.y:مt wr$Nv'BA᝜7>ﭓ](8(}I'PpPx' O{d  @{.y:مt wr$Nv~駟~駟?;PpPx' O{d  @{.y:مt wr$Nv'BA᝜7>ﭓ](8(}I'PpPx' O{d  wL\~eݧq;.i5-׍y#G|=+pmyf̫r(?OF7<ٳ{q 9d3ydgyc9G㘗shgu\㞱ޏ](8(y;jFb6wG^ z w~FyluR|W~zd}K.8U1=_-l,յcM{<z=5zvK{_f5+8'׷&cڑ<1=T3[OzONvN+Y͎Y}iֽf+5=w^}og=/=ZɪYm{;zkz}=PʸLղhϓLJ<~i籨jfylehԿ}9T5sۣ9+6{5Ws9BAVQ3qlyVs=ZF5լFu#?G3ʣfsXܿf{dhʚo6j=BAn3 uY{ơjfs5F?ydw~rV+^_3[jvcUfc;C3q wZ9oGM3c7zUkVCvjv895v=kh3sVjZZ;ڇ?4s4on|;{8مݼL}1QءǺW4q4i->Օ}x}1\ӛ[?xnG~FC.y,x~3ԫ;W{yNvʃrUUmkUwUs;Nd <(;k?_]sg>k).^yPv}ؿnu߇{.^yPv~u9U{1O{d <(;k?:=ߛ.^yPqmzQzfc<:م+W^hk{p8م+W^h{󳲧|['PxAY}=d <(;k_ykꮼ.~I|oBeg+c4_yMs8م+ʱN5ɪq[W{]N:مgFU~wu-#+5Ww+gY<م;e ug=߱;p_9c|*d  wsQͯ>=J +3gO BAVQSQynk&g6bMȜz{;ޫf,5cJ |gd  wssZ{8lΡ^Y.ƻv{{=^ 8'PpPxvfUmQa+j"Ozl돞կ*.8yDWYVW;^K|kgM|f߫cڣ{U.i5Uh:Uǣ4q4kg]|yϯx^:`3x 9(UYD+ح_Q׋{{[7].i596Z׿Rwsf׋{{֨景 BAn3*{ums+^WE_׵>>w^]o]5k:u}8م;wswkc^a.dgxպW5v~L6{W{_ᮯ.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.>](8('u =d  I|oB8(O?O?ą>.'PpDžd .""""PBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م#cFٶٶӲs.\%Oqz<爈|r .ԥKp,jbȧB]Zrˬ&ҫ]Ss{ii_>ǫ͛b}73ϹƳ9 u:(U}^mGce4oԿe6cĺ<'{͙UؕQ9v/Ϟ3+cx~ܫ,+u?j[{Էz59՜Yc(.Y%9Uշx/6v9~\KՁo91#q<׶G{y,.^f5ylr%׌ڱ?>ά&wf6gԍ=o^9nk5'Wʵ2ۣĺGɵ,׵r.PVjհ~3͉2笎֜%9ˬ&ư-nXҾ1YiӫQF5^Է派^,ܰ6'Guⱷ,Վj,^ڒk˳X՟sձ.Ѱ&ΝW۱?>M?6'j՞۽jر6-nXƜر6jج6ڰWQJ=Fϲ՞3l܎/'6۹?6]~PVѳ&['UܮR߳2󊱳۲՞۽ƪJjԱƳ^=6յwf6g殲v;}V16lԏձY՞Xʲ\۳Q}Ρ$қ7ٙǪĵXǼW?2յGuⱷԏz+v鍵9,8{^ˬ17,+VQ;Τ4?YFr<6m8?7֛fjw:cfcGxkı8?5 uCXZz5;-yv|ȱPB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](PB} j~\Ov~~~~BAsO:م܉$N|&BAsO:م܉$N|&BAsO:م܉$N|&BAsO:م܉$N|&BAsO:مBvjG5|Cmq^j} lL{c}g;~fm|>d  /vVvj>?yL곦ꚳŲ>A!9ԎuɞG=Ȳ8'Pvģͳa}L9BA!ѬͫƳeѿ67g6}?مǵs&+<7syG<]y=|.3q6<7p/;WGs~~yxOvࠐ휉oxdן|L>9?.3֟DzKܼ~NV}yOvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'P8 uAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.}Pyu}]{cWu:^ϳ4²G{Qiܽ#^Sم+ޕ5F[ǾèQlܲԹ+j;Ja_;z?13;ko^yܷR}=&5ݎ8ɴΨڽ]=uoֈ}è.{WBʚњ^aԿ͕+F5Ыک9+hQkT+5ϒ=بfhܳ嵣86亳;E+ܣܴJͳ5ԶYѲԳұڳ;:14ձѴܽհ/ڳӳVϚa<s[;窕5{5-Q5^/Y?\U:6X#{z.y #?i'PpP^]2^ #?k'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:م§5yG3ydgԏj[+_\?g'~yp}ɯjWvz:x; O;(zDuμwQ+=|~Ͱ<م§wAyG3ydg=Wxs}}s_ܭ{l9.}PF>ǽ彚#γ2ƴܳܳҳ汫zGҚ޳ݰF=6嬉jG덷j+봱[ћ7&Qѱbܝ^4'ǹWG5.ܲԹ#۳ڕjʿγ݊Zϯgꚰu9n3ܳ嚕9;z5cܱkӫɰҿ米n?2ټ<֫]ݴR7DẔծڱ/ϏQȬ>´1?5þܗv%֏þ1Ѳ77ڳ6ِc5#γ_[cͬ&W浾_o循=ڲ<ԍGfqlV73z+}CF㱯7ެԍGfylV;cM+FsZ<3ic#qn\+LJ](ͬf_fk̵>](<ruMRsuU+5պyhؿRsUFbJ͡s](<rkCg5WG?vWjڹ2Z'+5Q]e4/4UyhQ]ob&b_owۇè7'jV>/è72WQz7?^U^Sم+;нٳ76&=Z#^^ߊ8ǖ?]5ڲX4}ݩ97٨ŶٽѴܽ;f٨ˣl(lc;]շ7Ə<"ϏLXم'܍x ;j_'sW.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'B+ϛkwڻ^˳UwgX3Y}]p 8(;\3Z(+3oy<[SY^J_lf嚕9M]2'lۇ?8.}PV.f֞hbb[SY^J_l籦ir{&浱؟؞rz^Msd >(+3Ƴմ٭Ԏjn/ݓڻ侨k?ݓ6kGF&'PA۹Ljܳ3J&Vb;55Qհr+5؞zγ?>O샲rմ](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  <ӳR}>م rnVj'PpP8p?>Ov5Kq_~|FBA׈8p>Ovrn7~g.xvAWè{} cv9|FBA몋h} YjVu|FBAkV/ŹnuގW w|]w+^|NBAklh6 Z;p/>'Nv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>(8('Pʳθ5<}dwG9'PpPxe9:O1qվwG9'PpPxe9:Or;fgnݯn?9:م3/,ژ7~7SՌS\=m~lH֫92kz5-ͨ?d  ?^Vj;X=۹nn}^͡DW|BAZ|\ӛ׫9ӵ=;q|T[3v{㽾è:م3/ݴ&+}èvƫ4Ui^alBAz_h/vJ_k]Ǿai}ݴxˁWpNv /7z^J_g>>߱ǚݚãuݴxoڜ(8(<˫8^Mj vM.Œst g}y6>g[=볾8Grb^:م3̾X}Ěhc;Z9(֌{o&(=u .KܓPpP~>](8(}I'PpP;csΧ =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.""""" ';P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5<_XJ >IENDB`Scripts JScriptVersion M DefaultJScriptL_LinkDocN Section0W !"#$%&'()*+,-./0123456789:;<=>?ABCDEFGIJKOPQRSTUVXYZ[\]^_`abcdefghijklmnopqrstuvwxyzBodyText `{pPrvImage\tPrvTextDocOptions Section0WScripts JScriptVersion M DefaultJScriptL_LinkDocN  CONFIRMATION <Student ID No.><><Program & Major><><> <Name><><Contact No.><><> <><><><><> <v' If you have the following symptom(s) in the last 7 days, please tick the relevant box(es)> < % NO> < % YES><% Fever (37.5! or more) % Cough % Phlegm % Sore throat % Shortness of breath> <w' Have you visited overseas, any areas or facilities occurs COVID-19 infection in the last 14 days?> < % NO><> < % YES><% country/place : ( ) % When : 20 . . . to 20 . . .> <x' Among people who live with (family, roommates, housemates etc), Is there person who have been to overseas in the last 14 days?> < % NO><> < % YES ><% Relationship: ( ) % Region/City: ( ) % When : 20 . . . to 20 . . .> <y' Have you been in contact with a confirmed COVID-19 patient in the last 14 days?> < % NO><% YES> <I here by certify that the above information is true and correct. I understand that any falsification or omission of any facts will lead to civil >PNG  IHDRRsRGBgAMA a pHYsodsIDATx^ё+P?٢o! deJ .;'F@dh;vOs \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j`ݿ/OO)_~S[k?[_oY}/?)2oｖg{^>=/k[\7~O{߽  5߿Cڥ0_ZgB_]_/=bzpQ]%okᒶ?. s/]?e"9ۏq ^d~/k|E5껱^^Zk&½e6>ۿ)/$.AYsиPS[|3/wda#bt zi.E3\W^o&5h\G.\0o~'2zeKŵs"?5Ks/ۓw*iE9?yV @B }W'\fk-\ .??јCyx?4.@h%=_\{k`W{kC^dw_s^R~u{ˆWƅ_z5'S:Z^Te͙\. _ǾG]_0V }nj`R.wsck&Ko:w~pǏPNk4.#u4瑵~5-]T Z+P8|}ghr9ُY @B L_o" ao_M.Zu?/Fk =u6";^'\K닗B7 rOQsиPKԯ#?.>ʯ~.Ez~Q  u<1/y}->{ƅXo_eJR^Tk:l/Yu?Kʼݵwnj`YKF_?\J/LFY~[o-0\N_c_Úsz75ٿN\j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p \j.p.ON8 n%;' -d>_PSx̧ | TxC6^qήGw󎿃w{d>z5x:z7W٭Q?ḑ̾جndziv׋Zw0ۜ=2 O%jzz}X߫Ǝ*n6g6wekc_3;ןZ3wxs“|^}ǚ>ľ8Wνu`w;>jܳ?n;᳧ڇ=չl^^ѳͩگ>O>p83sj;Ս4³ç‹ۇY;V;en47>5<8r𬚨7z3+sG#;]`oW7[;ڇjһ>aV۱z5}}Ts{}zw9ۇjһ>}dy,cf6ۇQMuq^̮Gw󎿃տY]լjzM~w=9|*p mw~: ܂/(w)O@S[> |*p >On;' -d>_PSx̧ | T|AO}2 ܂/(w)O@S[> |*p >O紥>GߴSC/aM'Fx;6o47FcQcj^.|*|їDnVjgţ#kf6^/?+>O F݌ί +gD| ]ky(GTL^<>>=>v3꿋;6旯;+ҏ(ǧ‡Q]|ߴ|ܳѳ津3˿T/Q6꿋;6旯;}>*ⱷ4ҹL^<>>DK^;|Ah_5b;fU{W| bpcyz+|A\hir{f6״,l0W| ?w|;~N5' -d>_PSx̧ | T|AO}2 SDDDDNv[G > |*p >On;' -d>_PSx̧ | T|AO}2 7q|@>Gߍ/(}|ңݿ_q>Ԣ}!^Ǩ3ʲmʲgs²Ѵ/ʆ*χ#ԫ;<; >Ԣ}!/Ǻ>ĺʪب|һ7/ʬٳ3g՛۲Ѭ?꙰߃èӲ炻;;͵&v36ôͣ}Ta?ľj}^m7G=kp7ωM>wz=wn[zf5+}=iFl,ƱGߛOn;x7jY|*p >On;' -d>_PSx̧ | T|AO}2 ܂/(w)O@S[> |*Nc8 .p \j.p \j.p \j.p \j.p \j.p \j.p \j.p.OAp.?PBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](\ڜ^&+w6Eιϸp.v{亝]^K|xMm͕uc꜕ṳ+(Bմ9h״fݙ{+ҳʞg?3ҥٍG=\㣯y#OWƲ6ߛ7sNfڹUc9xTX/fY}7g77Fɵ~46jρ u:ƌ⼘<^շgsZٜج=o^bM_+wbƫYfVF[r_lƪqR۽Ě\۽Tsb{66JduNiz}:e6ge,Uy,yqǹQr]l?2gXρ u:ƌ⼘<^շgsZ9Umk[XWf㝱n}jlY]-/gcU{TGbM^9=eVVV:'UxmhFk1qle6'Ŵx/>]ڱ?>XuϰձƲ;ǹc9r<.ԥ03bxUj8gcTsZ;Gsy9&rZ(n^y{v{j{5q^5[N}m}1Qn=Vfs^rMl籘66%繽V;Js{Ռh?Fu=jrF㽹9Ruہy1yiqN|۳Qfsfc/ǫ͟&ϛWU]&ϋkg{=ڣǽv/Wyl%fuG۹?*y^lY(yNl籘66ɉyll5yh?iin%l,c|b(vgρ ui0C۫䚕91؞23rXWf^=cfc17=ε1yqjQfsrjNlF5ѱ*;vllVw2:2:6K5c|k(._1S^yp.vx{y-ַ2srͨ{sb_o\ڹ^m\#h,^{xgJǾ^mN/DZ^mc=JsrVQ;ܘXoNeH\77~$GujXkX8KxQm럥Whc&%9mX׫y,+s<.ԥpLYy=ggHV+_O+{[/\=>sB]zPBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](PB} vPO?O?مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt Wc희jG5Nvʃn7и+BegY}۩hNvʃ#9eݝ~'PxAY޼j](8(}I'PpPܓNv~駟~駟?;PpPܓNvN.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN5wݿuyopO6OvpRU1bZgKYћҌ<ka6ǼƳ\Xӫk}yc_O5n;gubM싹8?c>j\c;x:.b,6U&1Zgd}-}Տz4zYFUuG;v*;Yqxܫ5QnzuWz߁](8(Q8کL5o>oWVky{+}cvyE.^Qv^3jsJqȺ^j߮g؅]g׎jrƨffgNUG֋c۫_=O[Uv^+jguqlTZvk{z}?z+u}w`  4;o;gٵG(Ѭ49G{qvW7{8֛7JϨ켞Wب5_m絼veQnVVv=c.b,>?;Ȳ9fֿ:|ڕ==YЫ[5Pʳٲ9Ϯ}<?:kyvW7{83/۩}WY}:_i絼veF+hվ]X; 9ՍǾѼ֯7]y =+awݕ5={y+pfbM0 ;+{kzsf봴vԛڷk|vNvdnsTc5f*Wk4չ=uZ~Uƣ5(֌Wydj.jU7wo3BAIkaGo}q>NvʃrUUmkU\g_8#'PxAYm;]d <(W/3ؿnu1g?$Nvʃ##ϩ#<7#BegG^GSgy~g>ﭓ](B}{.^yPv־:Fs]w0f_$Nvʃ1{w{.p Wgnܟ:م+W^hꚳ+ l'PxAYͽW^}O{d <(;yhn^?'.y:م]gq'W#]ͮj#kzsh{'5,{y w{n{w;mfv^ի}ثwN?;Qe>6c_mwÞ3O? .ivvjG}Lz/9qnǚ\Xkblv^+j[3i}.y,DZ^M5jF#n6/D/7q<׍ݫ?ޕܿR<%7Hf>ᎾϢQյ?=;م]g۸αͪ'1ʰly:5kF53՜5yY}ʲ/޳(8(gƱ+ܳ5j!ֻ86[9쮳ܳݩժy;^}ʲ/޳(8(Y=GFϽ#ϳ](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.>](8('u 㠈H?PGDDDDR\OvB-"""ҏ .Psbz5""""㞃 uiB/ѽ戈|j .ԥՋ<w\K+ޅyԎ}""""^ ui/ʭ=oU5վQhhߝ,>ΏU͙Tx8>>=QjjƳ2,g=$zj췾6եڱoG+[R͝g=QNJr.ɥ=ڳ,6Y=Džbڳ1nܖ<>ڻʳ=h쏏sر6Œ㱫Nuvjsv>ܽ;6$l7sҳܹγ}ĺb1ΙU˳ڰ=o˳ؑ8άkV?Nl,'*Fwڪ3;dz;1ܿݲdޣܰ1#K5w6>덷xTV:n/&d6??ɵwe,{VkFy^nj[};jQ\K+)'GJ~Q 8w""Y uɗH?.'PpDžd .HDD$}i9~\K<;.'PpDžd .""""PBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd _}>uڲ1&ַ<ϒ{W_u ]ՏT+:%9"""?KT\K_}^JFq,yn?[mGmyo1ټ8s<W_E0>sxUKoNˉ5G۹?Ņx9wyl%՜5sn{oFDDDnŅ՗|lxUw;TGx/"""nŅv CDD>q>م H?.'PpDžd .""""PBZDDD](⧟~駟~g.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.>](kdUU;Ukw>ﭓ](쬽[;4 'PxAY{vVvjy- 'u W͉+<7pG8م+ڏUss:م+ڏUs?w](}v^Yw繹^I|oBegoxd;.^yPv־ZFGvk5.^yPv~Fm㳵w'Beggc>^˞I|oBX{'fجq_8م;9o|['PpPܓNvN.>](8('u =d  I|oBAsO:م;9o|['PpPܓNv~駟~駟?;PpPܓNvN.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.ƙg>qw.i5-+~5> g;~qg.89ճGnw}㮜͓](8(y;jFn;=ޝ>y߸+gd  ws*WTk6,ϖ޼n6bwޣ=x#d  rގ͉}ayGsxZ7~5Fk?;qG.8YQبnP+k=:0v>z}^9'PpPxvԬfGU?cݚCnZ4jU^qG.8UQ͛DZQn͡j79l^ikJ^qG.i5\Q͟DZQn͡jGmlujl?2_γ㎜˓](8(q&sZg6Fu5XRfszU潼oܕy wZ9oGM˳֌}aTSskvꏱ7ZTkw<}㮜͓](8(ͫ~LVz56>z5zj'֟jU\\Μϓ](kdUUڽd8彫gkg3x;gd <(;k?_]sg>q9/u>KOvʃ5gu9 'u WyyNyd <(;k?:=>I|oB67g6| Nvʃ1Ǽ+1 'u Wܫ+?w](}u>w{'.^yPv־:FsWל]y]gs8م+W^h賧|['PxA9ɣFs9Y5\NvN+͙.|'BAn3Lg:~ϖ+߻R,BAV[2y:UWjzߜ1>sx 9(WWWٞzVe3'sOvN+ᵳ&gUnou*gd  rގ*Wy?Q8u.gW<|x<مgrgh,juV֯|kl=?u.gd  rގg_]y;9[_ykl=]YkTpOvp7Ǚlyڽj:环Zy;ڮzŚW5>BAV;9z1Q0zs3j+W^W~[;?K^?&=ëֽ⎯pnd  @{.y:مt wr$Nv'BA᝜7>ﭓ](8(}I'PpPx' O{d  @{.y:مt wr$Nvp?~駟~駟~v~B]jFDDDD~](PB} _?_?~Džd kzk.kb\qt_/we|]gj9_-3NޑB]>e8]dzG]iϯ%W3瑵uɷɴ}ޯ8P῱ž?]ykIʲяgw='ݵ߃^<9.ԥѿ˟a_ӟߏ [/%ujgcTs5G?Ksx&қڹ\7j2osGuqJh>(՜nϻ53j56=ǽjJX=ʼ֗ӛ3z\z5j[X=ǹvQlk{YVn=ε9yW;['2S86j\qp.~/(.wJ}z59;;yպ|֞?~M9N^LB]/___׾ngDžd y~\Ov |"""JHd5…FDDD](PB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](B}<ϕ'bo~5=W+οV/XswY}Y/y4ąydWޯ;߯gFWU]I^'hs u]`òs/gsF*yN7f86Ks.JبeeNCs u]`2>{Xnjg[Y,ռ^{ydlڽTsfGfuyNnRG?{,.^bMmkrcUF4Kج=|u u]b3>^M3k?:k2Xάv66K5WjF^vı\ڣ3k?:6Ksr{jި==cYfkv/&{ıպc_o|\;[նveNrO\K Guv{3Gus=jv/՜֎ꏴ9Q;gu,ڣĺ<'GYXkg-X%yKvN%yXo*%׎1m7>˙!ąه%y,&ᲵDzڳҾ]ձ/9؎j36uⱷԏ2ű8ܱĺ<'{5j$s;&zշXKX/rһ>i|kR͉GzQZ]Lgc;VڽF}Ujά,.QVUu=zYb]۽Ě\%GǪT;؞\U]rO\K Gɵyި=oY,Um\/v6Vr_o\7j{sX/7g6>ڣVۭo%+zcqNsXK5oXv/&&X/.΍派YڝؑќXkzc"wq>q. {,DDδCsk\K>EDDDq>م H?.'PpDžd .""""PB?O?O??vv'BA᝜7>ﭓ](8(}I'PpPx' O{d  @{.y:مt wr$Nv'BX{'x|j ^þI|oBegY}olqW8م+ڻﭓ](HhN_Yw;.^yPv~7vk5.^yPv~7vy#Beg+ʺ;5O{d <(;k_}#; <Nvʃ7z<\c$Nvʃ3j[=d <(;k?덯ZO{d <(;Y5f5.y:مt wr$Nv'BA᝜7>ﭓ](8(}I'PpPx' O{d  @{.y:مt wr$Nv~駟~駟?;PpPx' O{d  @{.y:مt wr$Nv'BA᝜7>ﭓ](8(}I'PpPx' O{d  wL\~eݧq;.i5-׍y#G|=+pmyf̫r(?OF7<ٳ{q 9d3ydgyc9G㘗shgu\㞱ޏ](8(y;jFb6wG^ z w~FyluR|W~zd}K.8U1=_-l,յcM{<z=5zvK{_f5+8'׷&cڑ<1=T3[OzONvN+Y͎Y}iֽf+5=w^}og=/=ZɪYm{;zkz}=PʸLղhϓLJ<~i籨jfylehԿ}9T5sۣ9+6{5Ws9BAVQ3qlyVs=ZF5լFu#?G3ʣfsXܿf{dhʚo6j=BAn3 uY{ơjfs5F?ydw~rV+^_3[jvcUfc;C3q wZ9oGM3c7zUkVCvjv895v=kh3sVjZZ;ڇ?4s4on|;{8مݼL}1QءǺW4q4i->Օ}x}1\ӛ[?xnG~FC.y,x~3ԫ;W{yNvʃrUUmkUwUs;Nd <(;k?_]sg>k).^yPv}ؿnu߇{.^yPv~u9U{1O{d <(;k?:=ߛ.^yPqmzQzfc<:م+W^hk{p8م+W^h{󳲧|['PxAY}=d <(;k_ykꮼ.~I|oBeg+c4_yMs8م+ʱN5ɪq[W{]N:مgFU~wu-#+5Ww+gY<م;e ug=߱;p_9c|*d  wsQͯ>=J +3gO BAVQSQynk&g6bMȜz{;ޫf,5cJ |gd  wssZ{8lΡ^Y.ƻv{{=^ 8'PpPxvfUmQa+j"Ozl돞կ*.8yDWYVW;^K|kgM|f߫cڣ{U.i5Uh:Uǣ4q4kg]|yϯx^:`3x 9(UYD+ح_Q׋{{[7].i596Z׿Rwsf׋{{֨景 BAn3*{ums+^WE_׵>>w^]o]5k:u}8م;wswkc^a.dgxպW5v~L6{W{_ᮯ.>](8('u =d  I|oBAsO:م;9o|['PpPܓNvN.>](8('u =d  I|oB8(O?O?ą>.'PpDžd .""""PBZDDD](PB} j~\OvB-"""ҏ .\EDDDq>م#cFٶٶӲs.\%Oqz<爈|r .ԥKp,jbȧB]Zrˬ&ҫ]Ss{ii_>ǫ͛b}73ϹƳ9 u:(U}^mGce4oԿe6cĺ<'{͙UؕQ9v/Ϟ3+cx~ܫ,+u?j[{Էz59՜Yc(.Y%9Uշx/6v9~\KՁo91#q<׶G{y,.^f5ylr%׌ڱ?>ά&wf6gԍ=o^9nk5'Wʵ2ۣĺGɵ,׵r.PVjհ~3͉2笎֜%9ˬ&ư-nXҾ1YiӫQF5^Է派^,ܰ6'Guⱷ,Վj,^ڒk˳X՟sձ.Ѱ&ΝW۱?>M?6'j՞۽jر6-nXƜر6jج6ڰWQJ=Fϲ՞3l܎/'6۹?6]~PVѳ&['UܮR߳2󊱳۲՞۽ƪJjԱƳ^=6յwf6g殲v;}V16lԏձY՞Xʲ\۳Q}Ρ$қ7ٙǪĵXǼW?2յGuⱷԏz+v鍵9,8{^ˬ17,+VQ;Τ4?YFr<6m8?7֛fjw:cfcGxkı8?5 uCXZz5;-yv|ȱPB} j~\OvB-"""ҏ .\EDDDq>م H?.'PpDžd .""""PBZDDD](PB} j~\Ov~~~~BAsO:م܉$N|&BAsO:م܉$N|&BAsO:م܉$N|&BAsO:م܉$N|&BAsO:مBvjG5|Cmq^j} lL{c}g;~fm|>d  /vVvj>?yL곦ꚳŲ>A!9ԎuɞG=Ȳ8'Pvģͳa}L9BA!ѬͫƳeѿ67g6}?مǵs&+<7syG<]y=|.3q6<7p/;WGs~~yxOvࠐ휉oxdן|L>9?.3֟DzKܼ~NV}yOvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'PpPܓNvw3 I'P8 uAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.}Pyu}]{cWu:^ϳ4²G{Qiܽ#^Sم+ޕ5F[ǾèQlܲԹ+j;Ja_;z?13;ko^yܷR}=&5ݎ8ɴΨڽ]=uoֈ}è.{WBʚњ^aԿ͕+F5Ыک9+hQkT+5ϒ=بfhܳ嵣86亳;E+ܣܴJͳ5ԶYѲԳұڳ;:14ձѴܽհ/ڳӳVϚa<s[;窕5{5-Q5^/Y?\U:6X#{z.y #?i'PpP^]2^ #?k'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:م§5yG3ydgԏj[+_\?g'~yp}ɯjWvz:x; O;(zDuμwQ+=|~Ͱ<م§wAyG3ydg=Wxs}}s_ܭ{l9.}PF>ǽ彚#γ2ƴܳܳҳ汫zGҚ޳ݰF=6嬉jG덷j+봱[ћ7&Qѱbܝ^4'ǹWG5.ܲԹ#۳ڕjʿγ݊Zϯgꚰu9n3ܳ嚕9;z5cܱkӫɰҿ米n?2ټ<֫]ݴR7DẔծڱ/ϏQȬ>´1?5þܗv%֏þ1Ѳ77ڳ6ِc5#γ_[cͬ&W浾_o循=ڲ<ԍGfqlV73z+}CF㱯7ެԍGfylV;cM+FsZ<3ic#qn\+LJ](ͬf_fk̵>](<ruMRsuU+5պyhؿRsUFbJ͡s](<rkCg5WG?vWjڹ2Z'+5Q]e4/4UyhQ]ob&b_owۇè7'jV>/è72WQz7?^U^Sم+;нٳ76&=Z#^^ߊ8ǖ?]5ڲX4}ݩ97٨ŶٽѴܽ;f٨ˣl(lc;]շ7Ə<"ϏLXم'܍x ;j_'sW.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'B+ϛkwڻ^˳UwgX3Y}]p 8(;\3Z(+3oy<[SY^J_lf嚕9M]2'lۇ?8.}PV.f֞hbb[SY^J_l籦ir{&浱؟؞rz^Msd >(+3Ƴմ٭Ԏjn/ݓڻ侨k?ݓ6kGF&'PA۹Ljܳ3J&Vb;55Qհr+5؞zγ?>O샲rմ](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  <ӳR}>م rnVj'PpP8p?>Ov5Kq_~|FBA׈8p>Ovrn7~g.xvAWè{} cv9|FBA몋h} YjVu|FBAkV/ŹnuގW w|]w+^|NBAklh6 Z;p/>'Nv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.>(8('Pʳθ5<}dwG9'PpPxe9:O1qվwG9'PpPxe9:Or;fgnݯn?9:م3/,ژ7~7SՌS\=m~lH֫92kz5-ͨ?d  ?^Vj;X=۹nn}^͡DW|BAZ|\ӛ׫9ӵ=;q|T[3v{㽾è:م3/ݴ&+}èvƫ4Ui^alBAz_h/vJ_k]Ǿai}ݴxˁWpNv /7z^J_g>>߱ǚݚãuݴxoڜ(8(<˫8^Mj vM.Œst g}y6>g[=볾8Grb^:م3̾X}Ěhc;Z9(֌{o&(=u .KܓPpP~>](8(}I'PpP;csΧ =d  @{.>](8(}I'PpPܓNv'BAsO:مt =d  @{.""""" ';P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5\B P.p 5<_XJ >IENDB`W=K@~sZZLqo, :9ZTա:[PACpA.] n*R%m>I9$w $ Igc`,(Vz vيcŞ7i[ T.Z7dRE.PÁMx48 It:ҵE6yX-s괉l}Hס x;=zˆfFe؀(*,d yS>9NϦI 46ƻ?hPH+na\6zݜG@ WK%EzI]Jot 8&{X&Ij] !@ۀ¬K6hQuY6hPtui(a]}ږ-$.O ЦW֥Ӷh[¥JW;%s{HrŜ^ҍoct~8}9c8w?ag6-kBԆC[CtYY17;h7?|&e4#!ώi; wIz 3ǠJ];Oj9{gӃ1}5TNp;p ]Ft둡.9Z& 3eO #tѬCELF}sYUzXkaߩ+ӹ̊-`s?1iSNoo0ͣ|iN2n6kMs&Tz 2LwAGɍ1ڞ9Ad6\Ukr t?oᯃgkA/&o~0 f>q.踋uĺ_7m01=?G0YOXy6 &,>3o6ڬZߋ㛡bҳ8ղ<*mq m @|;d@n'7IZ^"1Bv`$1p56B m&S`t7c-ЃtЁIp`3kXn]U+5qa]XP4,`̀;âkCXʚ}ەJL^RC%e%=?VL^Qb%fT33%.+2P f =hUb-+RΜ#"D$K@V@ ""! `hxDBxHD3sVrmV{kE+g`=ZS\!z ^⤲"|Qtm XVU;j ~Z}X"~[gp'!o΃`b zqp`dq8m\MX|`a``a`0x  d p | } ajou2020D 4 8| ”| $ 3:57:03ajou 11, 0, 0, 3156 WIN32LEWindows_8@P |r @p1@HWP Document Filec`@nncd߈ .> <y' Have you been in contact with a confirmed COVID-19 patient in the last 14 days?> < % NO><% YES> <I here by certify that the above information is true and correct. I understand that any falsification or omission of any facts will lead to civil >WMh\U>7̤IIֈ}Ub"R("i6Sۤ5&L֤S2i.FН AqQpхݹ, n UQw}?{3d d{9wwB<أDUͿ|N4CZR_Li ~7mgx>,=9L{o0ErGC()BwKMYth[cOJkAkHm cVfhfFa{9y'K*Qra=V2PY#ӟ~25g8Q]~G>Y'\P ;CunQA3ϊaɣ DOœNpJSPnyZkT]]yt(k:0Ћ~iߍ1M8F@zc DEhÂ.<SGSN ~{, gT&u2 a33OF#ɶ d\km?b_~{x⿷em_FվFmqBr︜ y#ᩯu9B% B%B%†Y嶜KqYE)1e{JkUD&]x2` =]ADBx/=;͓HՆN@ȗце!_N"GBr|9J6@cAxπ5q"KyQ?6PYԐr]B :]K05O1<˭{+ԐJtV Ϙ-Bqw ?Z3UF܌84h D5}~FKnQIb oY/ΛLy-3Tdr*3Y5)Bo3UI&^1IX007P3{a%!?hꇐ*ܧ"?$sk(2MUUiF?/bbok8S5(kA㔧ݒV_9j)/!`RLB6"Y[nBIl-=D{c`Pe``bW& pAYr /8gH`2  !"#$%&'()*+,-./0123456789:;<=>?ABCDEFGIJKOPQRSTUVXYZ[\]^_`abcdefghijklmnopqrstuvwxyz