Follow the steps to successfully fill out the immunization certificate.

1. Click 'Get Form' button to access the certification form and open it in the appropriate online editor.
2. Complete Part I by entering your Student ID and Social Security Number. Fill in your full name, including last name, first name, and middle initial. Then, complete your address with street, city, state, and zip code. Indicate your age at the time of entering the college and enter your date of birth in the specified format (MM/DD/YYYY). Finally, sign your name in the designated area.
3. In Part II, your health care provider is responsible for filling out the required immunizations. They will need to indicate whether you have received the Measles, Mumps, and Rubella (MMR) vaccine or its equivalent. The provider should fill in the date of immunization and check the appropriate boxes depending on your vaccination history.
4. The health care provider will also need to document the administration of the Tetanus-Diphtheria booster if applicable. This section requires them to indicate whether you had a booster within the last ten years or completed the primary series.
5. For Varicella, your provider must choose the appropriate statement that applies to you, whether you have a history of the disease, laboratory evidence of immunity, or received the vaccine.
6. Additionally, for Hepatitis B, your health care provider must indicate your vaccination series status and check the relevant boxes.
7. If applicable, exemptions must be clearly stated by your health care provider. They will document any permanent medical contraindications or temporary exemptions with specific dates.
8. Your health care provider must complete their section by providing their name, address, signature, phone number, and the date.
9. If you are seeking a religious or distance learning exemption, make sure to complete Part III accurately, providing the necessary affirmations and statements. Be careful to understand the implications regarding potential exclusions.
10. Once all parts are completed, review the entire document for accuracy. Save your changes, and then download, print, or share the completed form as needed.

Complete your Floyd College Certificate Of Immunization online today to ensure your readiness for enrollment.