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Get UIC On-Campus Housing Medical Immunization Form 2016

Office of the Registrar, MC 018 University of Illinois at Chicago Suite 2130 Student Services Building 1200 West Harrison St. Chicago, Illinois 60607 ON-CAMPUS HOUSING MEDICAL IMMUNIZATION FORM PART I: To be completed by students in on-campus housing owned, operated, and/or maintained by UIC. (312) 413-0464 (312) 355-4481 fax mi uic.edu FOR OFFICE USE University Identification Number (UIN) Complete Incomplete Updated Duplicate RC Last Name City Address (number and street) M Gender D.

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