Flu Shot Request Form
Location: Building 900 Cafeteria - outside, in front of Health Services lobby
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Email *
First and Last Name *
Date of Birth *
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Student ID Number *
Phone Number *
I am in the following age group *
Desired Flu Shot date *
Monday thru Thursday 11 am - 2pm (Starting August 29, 2022)
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Time
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Preferred Flu shot *
Payment Option *
SHS does not give out change. If you select the cash option, the exact amount is required.
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