COVID-19 Vaccine Registration for International Students Living on Campus

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This form is intended for international students living on campus who do not have access to any COVID-19 vaccine booster in their home country and cannot obtain one before arrival in the United States, and indicates that the student agrees to receive the COVID-19 booster on campus upon arrival.

*This form MUST be completed by January, 20, 2022*

After all information is received, the Student Health Services will send a message to the student's Stony Brook email account with the dates and times of when they will receive their COVID-19 vaccine.

Email *

First Name *

Last Name *

Stony Brook ID Number (SBU ID) *

Stony Brook Email Address (i.e. john.doe@stonybrook.edu) *

Phone Number (please include country code) *

Campus Housing Location (please include your building and room number) *

Please indicate the name and date(s) of your COVID vaccine

Please read carefully and acknowledge you understand the following: *

I verify that I am currently residing outside of the US and either do not have access to a COVID vaccine booster and agree to receive a free COVID-19 vaccine booster on campus on a date/time that will be communicated via email. I also understand I will be required to participate in free on-campus COVID-19 testing once per week until I receive my booster.

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