COVID-19 Vaccine Request
Hello De Anza College Students and Families! Anyone 12+ living in the US (regardless of insurance and immigration status) is now eligible for free a COVID-19 vaccine.
Fill out this request form and we will contact you to schedule an appointment on a date and time that works for you.
Sign in to Google to save your progress. Learn more
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Last Name *
Email *
Phone number *
xxx-xxx-xxxx
Zip code
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