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UNIVERSITY OF NORTH CAROLINA HOSPITALS VACCINATION VERIFICATION FORM Legal Name: Date of Birth: Job Title: THIS FORM MUST BE COMPLETED AND SIGNED BY YOUR PERSONAL PHYSICIAN/NURSE PRACTITIONER/ PHYSICIAN

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The University of North Carolina is a public university system in North Carolina, consisting of 17 institutions across the state.

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All institutions that are part of the University of North Carolina system are required to file.

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Information such as budget details, enrollment numbers, graduation rates, and faculty demographics must be reported on the University of North Carolina filing.