Get the free influenza vaccination attestation statement - DU Student Affairs
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Name ___Date of Birth___University ID ___REQUEST FOR NONMEDICAL EXEMPTION FROM UNIVERSITY OF DENVER INFLUENZA (FLU) VACCINATION REQUIREMENT DU continues to require that students, faculty, and staff
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How to fill out influenza vaccination attestation statement
How to fill out influenza vaccination attestation statement
01
Read the influenza vaccination attestation statement carefully.
02
Provide your personal information such as name, date of birth, and contact details.
03
Indicate whether you have received the influenza vaccination or not.
04
If you have received the vaccination, provide the date of vaccination and the name of the healthcare professional or vaccination center where you received it.
05
If you haven't received the vaccination, state the reason for exemption if applicable.
06
Sign and date the attestation statement to certify the accuracy of the information provided.
Who needs influenza vaccination attestation statement?
01
Individuals who are required to provide proof of influenza vaccination may need to fill out the influenza vaccination attestation statement.
02
This requirement can vary depending on the specific organization, institution, or activity involved.
03
Common examples include healthcare workers, students, employees in certain industries, and individuals participating in high-risk activities or events.
04
It is advisable to check with the relevant authority or organization to determine if you need to fill out the attestation statement for influenza vaccination.
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What is influenza vaccination attestation statement?
The influenza vaccination attestation statement is a form that individuals or organizations may be required to fill out to affirm that they have received the influenza vaccine.
Who is required to file influenza vaccination attestation statement?
The individuals or organizations required to file the influenza vaccination attestation statement may vary depending on local regulations and policies. It is advisable to consult the relevant authorities or guidelines to determine who is required to file the statement.
How to fill out influenza vaccination attestation statement?
To fill out the influenza vaccination attestation statement, you will need to provide the required information as specified on the form. This may include your personal details, proof of vaccination, and any other relevant information.
What is the purpose of influenza vaccination attestation statement?
The purpose of the influenza vaccination attestation statement is to ensure compliance with vaccination requirements and to track the number of vaccinated individuals or organizations. It helps promote public health and prevent the spread of influenza.
What information must be reported on influenza vaccination attestation statement?
The specific information required to be reported on the influenza vaccination attestation statement may vary, but it typically includes personal details (such as name, contact information), vaccination details (such as date and type of vaccine), and any additional information as specified by the form.
When is the deadline to file influenza vaccination attestation statement in 2023?
The deadline to file the influenza vaccination attestation statement in 2023 may vary depending on local regulations and policies. It is advisable to consult the relevant authorities or guidelines to determine the specific deadline.
What is the penalty for the late filing of influenza vaccination attestation statement?
The penalties for late filing of the influenza vaccination attestation statement may vary depending on local regulations and policies. It is advisable to consult the relevant authorities or guidelines to determine the specific penalties and consequences for late filing.
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