Certificate Of Immunization - Fort Valley State University: Fill out & sign online

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Click ‘Get Form’ to open the Certificate of Immunization in the editor.
Begin by filling out your personal information in Part I. Enter your last name, first name, date of birth, and contact details including your home address, cell phone number, home phone number, and email.
Indicate your gender by circling 'Male' or 'Female'. As a fully online student, ensure you complete only Part I.
Move to Part II for your health care provider to complete. This section includes required immunizations such as M.M.R., Meningococcal Vaccine, Tetanus-Diphtheria, Varicella, Hepatitis B Series, and TB Test. Ensure that each dose is documented accurately with dates.
If applicable, check any exemptions and have your health care provider sign and date the form before submission.
Finally, save your completed form and return it to Fort Valley State University’s Office of Recruitment and Admissions.

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