Northwestern State University of Louisiana - Northwestern 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Social Security Number and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for your records.
3. Fill in your full name, including Last, First, and Middle names. Use clear and legible handwriting if you are printing.
4. Provide your complete address, including City, State, and ZIP Code. This helps the university contact you if necessary.
5. In the immunization section, indicate the dates for each required vaccine. If applicable, check the box for exemptions and provide reasons as needed.
6. Ensure that a physician or health care provider verifies your immunizations by signing and dating the form at the bottom.
7. Review all entries for completeness before saving or exporting your document to submit it to Northwestern State University.

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