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Adult Vaccination Form
The CDC considers someone to be fully vaccinated two weeks after the second dose of either the Pfizer or Moderna vaccine, or two weeks after a single dose of the Johnson & Johnson vaccine.
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Student Name
*
Your answer
Date of your J&J COVID vaccine, or date of your second Moderna or Pfizer COVID vaccine:
*
MM
/
DD
/
YYYY
Date you will be considered to be fully vaccinated (two weeks after the above date):
*
MM
/
DD
/
YYYY
Have you received a COVID booster shot?
*
Yes
No
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