Strayer University District of Columbia Vaccination Form Vaccination 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Student Name and Student ID Number at the top of the form. This information is essential for identification purposes.
3. Next, provide your Date of Birth. Ensure this is accurate as it may be used for verification.
4. In the RECORD OF IMMUNIZATION section, have your doctor complete the required vaccination details. If you have official immunization records, you can upload them directly.
5. For each vaccine listed (MMR, Td/Tdap, Hepatitis B, Varicella), enter the dates of each dose as instructed. If you have laboratory evidence of immunity, please indicate this by initialing where specified.
6. If applicable, complete the Medical Exemption or Religious Exemption sections by providing necessary details on an attached page.
7. Finally, sign and date the certification statement at the bottom to confirm that all information provided is accurate.

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