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Hepatitis B Immunization Health History Form ALL FIRST-TIME PELLISSIPPI STATE STUDENTS MUST SIGN THIS FORM PRIOR TO ENROLLING FOR CLASS. Name Last/first/MI Date of birth Social Security number* —

How to fill out pellissippi state immunization form

How to fill out pellissippi state immunization form:

1. Download the immunization form from the Pellissippi State website or obtain a physical copy from the campus health center.
2. Provide your personal information such as name, date of birth, and student ID number.
3. Fill out the relevant sections regarding your immunization history, including the vaccines received and the dates they were administered. Make sure to include the required vaccines such as measles, mumps, rubella, and tetanus.
4. If you are unable to provide proof of immunizations, complete the exemption section or provide a valid medical or religious waiver.
5. Sign and date the form to confirm its accuracy.
6. Submit the completed form to the campus health center or the designated office at Pellissippi State.

Who needs pellissippi state immunization form:

1. All students who are planning to enroll at Pellissippi State, whether they are attending classes on-campus or online, need to submit the immunization form.
2. This requirement applies to both undergraduate and graduate students.
3. Students who are transferring from another institution or returning to Pellissippi State after a period of absence must also provide the immunization form.

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What is pellissippi state immunization form?

The Pellissippi State Immunization Form is a document required by Pellissippi State Community College to record the immunization status of students.

Who is required to file pellissippi state immunization form?

Students enrolled at Pellissippi State Community College, particularly those taking certain credit courses, are required to file the immunization form.

How to fill out pellissippi state immunization form?

To fill out the Pellissippi State Immunization Form, students must provide their personal information and details about their immunizations, including the dates of vaccinations.

What is the purpose of pellissippi state immunization form?

The purpose of the Pellissippi State Immunization Form is to ensure that students are up-to-date on required vaccinations for their health and safety, as well as to comply with state regulations.

What information must be reported on pellissippi state immunization form?

The form must report personal information such as the student's name and date of birth, along with details of vaccinations received, including the type of vaccine and dates administered.