Skip to main content
Menu
Tertiary Navigation
Title IX/SIM
Main navigation
About ETBU
Academics
Admissions
Life on the Hill
Athletics
ETBU Now
Calendars
Events
Give Online
Hilltop Magazine
Media
News
Brand Standard
Info For
Current Students
Faculty and Staff
Future Students
Adult Education
Graduate Programs
Undergraduates
Alumni
Online
Parents
Employment
ETBU Health Services
Request Info
Visit ETBU
Apply Now
Give
Human Resources Vaccination Reporting Form
You must have JavaScript enabled to use this form.
Select your description
- Select -
Faculty
Staff
Student
Student ID Number
Name
First Name
Last Name
ETBU email address
Phone
Please select the option that best describes your vaccination status
- Select -
I am fully vaccinated.
I am partially vaccinated.
Please select the best description for your status
- Select -
I need to submit my vaccination information for the first time.
I previously submitted my vaccination record to ETBU Human Resources and do not need to update or resubmit.
I previously submitted my vaccination record to ETBU Human resources, but I would like to update with additional information.
Vaccine Manufacturer
- Select -
Moderna
Pfizer-BioNTech
Johnson & Johnson
Date of First Vaccination
Date of Second Vaccination (if applicable)
Date of Third Vaccination (if applicable)
Date of Fourth Vaccination (if applicable)
Please upload your COVID-19 Vaccination Card here
Please upload your COVID-19 Vaccination Exemption Documentation here. If you have questions or concerns regarding providing documentation, please reach out to Tara Bachtel at
tbachtel@huijiezdh.com
.
One file only.
75 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Main navigation
About ETBU
Academics
Admissions
Life on the Hill
Athletics
ETBU Now
Info For
Title IX/SIM
ETBU Health Services
Request Info
Visit ETBU
Apply Now
Give
葫芦岛房地产网
Macau-New-Portuguese-capital-customerservice@remodelinform.com
彩票平台
" class="hidden">中华儿女报刊社
lol-periphery-info@zcgongchuang.com
淘发客卖家工具箱
斗罗漫画网
极速漫画
深圳兼职网
都昌新闻网
青晨科技
Parisian-sales@scyhoa.com
Online-gambling-platform-marketing@apartamentospueblosblancos.com
买球网站
A-surname-media@kuyax.net
北海电视网
365-Sports-Betting-hr@bjseiwooeng.com
上海迪士尼乐园
百家乐
彩票平台
知识文库
日记100字
济南铁路局
高速宝全国高速公路电子地图导航平台
国科海博
搜狗站长平台
武汉生物工程学院
拜尔地板官网
捎东西
应届生求职网职位搜索
中国MBA网
诸城网
站点地图
广东高职高考网
老调网