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Clark University Health Services Undergraduate Immunization Record Legal Name (Last, First):___ Preferred Name:___Date of Birth: ___(MM/DD/YYY) Sex assigned at birth: ___ Gender: ___ Year Entered:___Pronouns:
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How to fill out undergrad immunization form

01
Obtain a copy of the undergrad immunization form from your university's health services or student affairs office.
02
Gather all necessary vaccination records, including dates of immunizations and vaccine types.
03
carefully review the form and make sure to fill out your personal information accurately.
04
Fill in the dates of each vaccination you have received, as well as any relevant medical history or exemptions.
05
If needed, have a healthcare provider sign off on the form to verify the information provided.
06
Submit the completed form to the appropriate office at your university before the deadline.

Who needs undergrad immunization form?

01
All incoming undergrad students at the university are required to fill out and submit an immunization form.

What is Undergrad Immunization - Clark University Form?

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The undergrad immunization form is a document that students need to fill out to provide information about their immunization status.
All undergraduate students at the university are required to file the undergrad immunization form.
Students can fill out the undergrad immunization form online through the university's student portal.
The purpose of the undergrad immunization form is to ensure that all students are up to date on their required vaccinations to prevent the spread of communicable diseases on campus.
The undergrad immunization form requires students to report their vaccination history, including dates of immunizations and types of vaccines received.
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