Holyoke Community College Request to Transfer Immunization Records
By completing this form, the student consents to the release of their immunization records by the College to a specifically designated college or yourself. Please allow 5 business days to process.
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Email *
Student Full Legal Name *
Your HCC Student ID#  *
Student's Phone Number *
Please indicate year attended *
College Name *
Name of the College the immunization records are to be sent.
College Address (Street, City, State, Zip Code) *
Address of the College the records are to be sent.
Attention to:
Name of person or department receiving the immunization records.
College Fax Number *
College fax number to send requested transfer of immunization records.
College Email *
College email to send requested transfer of immunization records.
Do you need a copy of you immunization records for yourself? *
Student's Signature *
Type in your full name to provide consent for your request to be processed.
Request Date *
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