Eiu immunization form 2025

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The document is an immunization form for international students at Eastern Illinois University, outlining the required vaccinations (three Diphtheria/Tetanus and two MMR) and compliance policies. It must be completed by a physician or nurse and submitted by the first day of classes to avoid registration holds and additional fees. The form includes sections for personal information, immunization details, and parental consent for minors.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information. Fill in your name, E# (student ID), birthday, and gender in the designated fields.
Indicate the term you are entering EIU by selecting the semester and year from the dropdown options.
Ensure that a physician or nurse completes the verification section. They must provide their name, signature, address, telephone number, and date of completion.
Fill out the required immunizations section with the month, day, and year for each vaccine received. Make sure to include three Diphtheria/Tetanus dates and two MMR dates as specified.
If applicable, a parent or legal guardian should sign in the authorization section if you are under 18 at arrival. Include their signature and date.
Review all entries for accuracy before submitting. Save your completed form using our platform’s export feature.

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