Get Immunization Verification Form - Newbury College

Completing the immunization verification form for Newbury College is a crucial step in ensuring your eligibility for registration and attendance. This guide provides a clear, step-by-step approach to help you fill out the form accurately and confidently.

Follow the steps to successfully complete your immunization verification form.

1. Press the ‘Get Form’ button to access the immunization verification form and open it for editing.
2. Begin with Part I, where you will complete your personal information, including your first name, middle name, last name, address, and contact numbers.
3. In Part I, provide your Newbury College student ID number, date of birth, and gender, as well as your anticipated date of enrollment.
4. List your emergency contact's name, phone number, and relationship to you. Additionally, select whether you are a commuter or a resident.
5. Proceed to Part II, where a health care provider will complete and sign the necessary sections, including your immunization history.
6. For each vaccine category, such as tetanus diphtheria pertussis, MMR, hepatitis B, meningitis, tuberculosis, and varicella, ensure the provider enters the exact dates of vaccinations received or serological results.
7. The health care provider must also include their signature, name, address, and phone number in the designated areas to validate the information provided.
8. Review the completed form thoroughly to ensure that all fields are filled out completely and legibly before submission.
9. Once the form is completed and signed, save your changes, and consider creating a personal copy for your records before submitting it.
10. Submit the completed immunization verification form to the Office of Residence Life as instructed. You may download, print, or share it as needed.

Ensure you complete your documents online and submit your immunization verification form promptly to facilitate your registration process.