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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Personal Information section. Enter your Last Name, Given Names, Date of Birth, Gender, Student Number, and contact details including your personal and Michener email addresses.
Complete Section A regarding Accommodation/Accessibility Services if applicable. Ensure you upload any required documents to the student portal by the program due date.
In Section B, review the Policy for Student Placements. Make sure you understand the immunization requirements and their importance for clinical practice.
Fill out Section C with your Immunization Requirements. Provide dates and results for each vaccination as specified, ensuring all entries are legible.
Complete Section D regarding Tuberculosis Surveillance Requirements. Document your TB test results accurately.
In Section E, indicate any recommended vaccinations received, such as Influenza or Covid-19 vaccines.
Finally, sign the Student Authorization section and ensure a health care professional completes their part before submission.

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