Get Immunization Form

Filling out the Immunization Form is a crucial step for students entering the Intensive English Program at Kennesaw State University. This guide provides clear instructions on how to complete the form accurately and efficiently online.

Follow the steps to complete your Immunization Form online.

1. Press the ‘Get Form’ button to obtain the Immunization Form and open it in your designated editor.
2. Begin by filling out your last name and first name in the respective fields. Ensure that the names are spelled correctly, as they should match your legal identification.
3. Enter your date of birth in the format of month, day, and year. This is important for verifying your identity and eligibility for immunizations.
4. Complete the sections regarding your immunizations. You will need to provide dates for immunizations received for measles, mumps, rubella (MMR), Dtap (diphtheria, tetanus, pertussis), varicella (chicken pox), and hepatitis B if you are 18 years old or younger.
5. If applicable, indicate your meningitis immunization date if you reside in the dorms. Make sure to fill out all fields accurately as this data is essential for your health records.
6. Consult with a healthcare provider to have them sign and complete their information at the bottom of the form, including their name, address, and phone number.
7. If you have a temporary or permanent medical exemption, please indicate the status and attach any required explanations. Ensure to provide the date by which any temporary exemptions will end.
8. If you are declaring a religious exemption, fill out the designated area and provide your signature along with the date. Be aware of the implications such exemptions might carry during disease outbreaks.
9. After completing all sections, review your information for accuracy. You can now choose to save your changes, download a copy for your records, print the form, or share it via email.

Complete your Immunization Form online today to ensure your enrollment in the Intensive English Program!