IMMUNIZATION FORM DOMESTIC STUDENTS ONLY 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your full name, including last, first, and middle initial. Fill in your birthday and gender accurately.
3. Indicate the term you are entering Eastern Illinois University by selecting the appropriate semester and year.
4. In the 'Required Immunizations' section, provide the dates for each vaccine listed. Ensure you include at least three doses of Diphtheria, Tetanus, and Pertussis vaccines, with one being Tdap within the last ten years.
5. For 'Recommended Immunizations', fill in the dates for any additional vaccines you have received such as COVID-19 or Hepatitis A/B.
6. Ensure that a health care provider signs and dates the form, verifying that all immunizations were administered.
7. If applicable, a parent or legal guardian must sign to authorize medical care for minors under 18.

Start filling out your IMMUNIZATION FORM today using our platform for free!