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NT INFORMATION (please type or print legibly) Name: Major/Program: Last DOB: First / / Mo Quarter Starting: UW Student Number: Day Yr Email: Local phone #: Local Address: Street City State Zip code REQUIRED: The University of Washington's Campus Health Services (CHS) program administers the Health Sciences Immunization Program (HSIP). The HSIP reviews students' documentation of immunizations and other protections, such as tuberculosis surveillance; makes recommendations regardin.
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