Information And Actions Being Taken Related To COVID-19
The Military College of South Carolina
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Confirmation of Vaccination Form


This information will only be used internally by Human Resources. Data on the total number vaccinated will be shared with administration, but your individual submission will be held in strict confidence.

Complete this form only when you have received your first vaccination for the COVID-19 virus.



Status (*)





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Name (*)

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Department (*)

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Contact Phone (*)

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Contact Email (*)

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Medical Provider for Vaccine (MUSC, Roper, Doctor's Office, etc.) (*)

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Date of First Vaccination (*)

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Expected / Completed Date of Second Vaccination (*)

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Please attach a copy of your vaccination card. You may be required to show proof of your vaccination should vaccination become mandatory in the future. (*)

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