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Revision November 2021-Page 1 of 2Fort Valley State University Required Certificate of Immunization Return completed form to the university. Retain a copy of the completed form for your records. STUDENT

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How to fill out immunization form 2021-12

01

Obtain the immunization form 2021-12 from the relevant healthcare provider or organization.

02

Fill out all the required personal information accurately, including name, date of birth, and contact details.

03

Provide details of all vaccinations received, including dates and types of vaccines.

04

Include any relevant medical history or pre-existing conditions that may impact immunization.

05

Sign and date the form to confirm the accuracy of the information provided.

Who needs immunization form 2021-12?

01

Anyone who requires proof of immunization for travel, school enrollment, employment, or other purposes.

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What is immunization form 12?

Immunization form 12 is a document used to report vaccination records.

Who is required to file immunization form 12?

Parents or guardians of school-aged children are required to file immunization form 12.

How to fill out immunization form 12?

Immunization form 12 should be filled out with the child's vaccination records, including dates and types of vaccines received.

What is the purpose of immunization form 12?

The purpose of immunization form 12 is to ensure that children are up-to-date on their vaccinations for school entry requirements.

What information must be reported on immunization form 12?

The information reported on immunization form 12 should include the child's name, date of birth, vaccination dates, and vaccine types.

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