IMMUNIZATION FORM DOMESTIC STUDENTS ONLY 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your full name, including last, first, and middle initial. Ensure that you also provide your student ID number (E#) for identification.
3. Fill in your birthday by selecting the month, day, and year from the dropdown menus provided.
4. Indicate your gender and the term you are entering Eastern Illinois University by filling in the respective fields.
5. In the 'Required Immunizations' section, enter the dates of your most current vaccines for DTP, Tdap, MMR, and Meningococcal. Make sure to follow the guidelines regarding dosage requirements.
6. For 'Recommended Immunizations', provide dates for any additional vaccines such as COVID-19 or Hepatitis. If applicable, include the date of Chickenpox disease.
7. Ensure that a health care provider signs and dates the form at the bottom to verify your immunization records.
8. If you are a minor under 18 years old, have your parent or legal guardian sign their consent on the designated line.

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