Follow the steps to successfully complete your immunization record form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide your last name, first name, middle initial, and Social Security number in the designated fields. Make sure this information is accurate.
3. Fill in your permanent address, including city, state, zip code, area code/phone number, and email address.
4. Select your class entering (freshman, sophomore, junior, senior, graduate, or professional) by checking the appropriate box.
5. Indicate whether you have previously been enrolled at FAMU and, if applicable, provide the semester and year of your last enrollment.
6. Complete the insurance information section, including the name of the insurance company, its phone number, address, policy number, group number, and indicate if it is an HMO/PPO.
7. Identify an emergency contact by providing their name, relationship to you, and home/cell and work phone numbers.
8. Fill out the family health history and personal health history sections, providing honest and accurate information regarding any health-related conditions or allergies.
9. In the immunization section, ensure the required immunizations are documented, including MMR, meningococcal meningitis, and hepatitis B. Attach any required lab results if applicable.
10. Under Part 2 of the form, acknowledge understanding of the immunization requirements. Decline any vaccines if necessary by checking the appropriate boxes.
11. Sign and date the form, ensuring the signature is clear and matches personal identification.
12. Complete the required authorization for care if you are under the age of 18, including a signature from a parent or guardian.
13. Once everything is filled out, review the form for accuracy, save the changes, and proceed to download, print, or share the form as instructed.

Take the next step in your enrollment process by completing your immunization record form online today.