Get Student Immunization Record Form - Suny Empire State College - Esc

Completing the Student Immunization Record Form is an essential step for enrollment at SUNY Empire State College. This guide provides clear instructions on how to accurately fill out each section of the form online, ensuring all necessary information is properly submitted.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Student Immunization Record Form and open it in your preferred editor.
2. Enter the student's name in the provided field, ensuring it matches official documentation.
3. Input the student's ID number in the designated area to assist with identification.
4. Fill in the home address accurately, using appropriate formatting to ensure clarity.
5. Provide the date of birth in the required format, ensuring consistency.
6. Enter the phone number, making sure all digits are correct for potential communication.
7. Input the email address where the user can receive notifications and correspondence.
8. In Part I, all students (except those in specific programs) must check the appropriate box regarding meningococcal meningitis immunization and provide the date received, if applicable.
9. In Part I, students must sign the form, confirming the accuracy of the information, and include the date of the signature.
10. In Part II, provide details about the immunizations for measles, mumps, and rubella, inputting the dates for vaccines received and any disease history.
11. Ensure that the licensed health care practitioner's section is filled out if required, including their signature and printed name, along with their contact details.
12. Review the entire form for accuracy and completeness.
13. Once completed, save the changes to the document, and consider downloading or printing it for your records.
14. Return the completed form to the Admissions Office of Empire State College through the designated means.

Encourage others to complete their Student Immunization Record Form online to ensure a smooth enrollment process.