Visitor Vaccination Verification Submission

name must match vaccine card
name must match vaccine card
enter a valid email address
please include 10 - digit number
please select an option from the drop down
please enter the name of the department or individual sponsoring the visit
Attachments:
Max file size=2GB
please upload the images of a valid government issued ID and the English version of your vaccination card
please select the vaccine type obtained
please enter the date of the first dose administered
Please enter the date of the second dose administered. If you received a single dose enter the same date twice.
please enter the date of the third dose
please select the vaccine type obtained
By checking this box, I certify that I have submitted an accurate and authentic government issued ID and a valid vaccination card.
Check-in with security is required at all campus buildings. Proof of vaccination does not guarantee campus access.

Email Receipt