Employee COVID-19 Vaccine Reporting   Form
CCAD faculty and staff can use this form to report their COVID-19 vaccination status. Submission of documentation confirming vaccination for those who have received the vaccine is required so that we can report accurate, verified percentages. No identifiable information will be shared and these records will be kept confidential and stored with the Human Resources Department. If you have questions, please email humanresources@ccad.edu.
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Email *
Legal First Name *
Chosen First Name (if different than legal first name)
Last Name *
Indicate your vaccination status. *
How to upload your vaccine documentation
After clicking the Submit button below, you will be directed to a secure upload site to submit your vaccine documentation.
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