EmailMeForm
Students : COVID 19 Vaccination & Immunization
Complete this form to upload a copy of your COVID-19 vaccination card and/or Immunization record.
Full Name:
*
Prefix
First
Last
Suffix
Student ID Number:
*
Phone:
*
###
-
###
-
####
Shaw Email
*
Classification:
*
Please select
New Freshman
New Transfer
Returning or Readmit
Off-Campus
Off-Campus Address:
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Upload: COVID-19 Vaccination card and/or Immunization record
*
Add File
Allowed file types include pdf, png, jpg, jpeg, and gif.
