Draft - do not submit - State of New Jersey - nj 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the required fields such as *School ID and *County. Ensure accuracy as this information is crucial for processing.
3. Fill in the *Name of School/Child Care Facility and provide the Mailing Address, including *Street, *City, and *Zip Code. If applicable, include the School Address if different from the mailing address.
4. Complete the section for the person filling out the form by entering their name, telephone number, and school email address.
5. Indicate the total enrollment of your school or child care center and select whether it is a Public or Non-Public institution.
6. In the immunization status section, accurately report on pupils meeting all requirements, provisional admittance, medical exemptions, religious exemptions, and those with unknown status for each grade level.
7. If applicable, respond to the Influenza Vaccine Implementation Survey question before finalizing your submission.
8. Once all fields are completed accurately, click 'Submit' to finalize your report. You can also print a copy for your records.

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