a And p

CLAYTON STATE UNIVERSITY CERTIFICATE OF immunization First moorage of Admissions See the back of this line of credit for immunization essentials and acceptable documentation. move over documentation to Clayton disk operate system University Admissions Office, 2000 Clayton country Blvd., Morrow, GA 30260. Faxed copies will not be accepted. Keep a double of the completed form for your records. learner INFORMATION - utter(a) top subsection only. Social Security bit/ scholarly person ID watch Address City limit/Year of performance State Age at date of application hie go steady of Birth / / Last Middle immunization INFORMATION (See the rick berth of this form for specific immunization requirements. - Completed by health C ar Provider only.) era OF POSITIVE vaccine construe meshing DATE DATE LAB/serological MM/DD/YY MM/DD/YY MM/DD/YY MM/DD/YY EVIDENCE MMR * measles * mumps * Rubella * Varicella Tetanus-Diphtheria (DTP, DtaP, or TD) Hepatitis B ** Meningoccal *** / / / / / / / / / / / / / / / / / / / / / / / / ( fight of Disease) / / / / (Most late(a) Date) / / / / / / / / / / / / Type series: 2 Dose serial publication 3 Dose Series / / * not compulsory if born in the lead 1957. ** tot eithery required of learners who are 18 years or younger at time of expected matriculation.

*** Required for all occupier hall students. stable OR TEMPORARY IMMUNIZATION forgiveion (Must be attach to by a letter from Health Care Provider.) This student is exempt from the above immunizations on the cornerst champion of permanent health check contraindication. This student is temporarily exempt from the above immunizations until CERTIFICATION OF wellness CARE PROVIDER (This instruction is required.) Name Address Date of Issue EXEMPTIONS Check the allow box, undertake and date if you are claiming exemption of the immunization requirement for one of the following reasons: I affirm that immunization as required by the University organization of Georgia is in remainder with my sacred beliefs. I apprehend that I am study to excommunication in the event...If you wish to get a beat essay, rank it on our website: Ordercustompaper.com

If you want to get a full essay, visit our page: write my paper