COVID-19 Vaccination Record Card

Select your description

Student ID Number

First Name

Last Name

ETBU email address

Phone

Vaccine Manufacturer

Date of First Vaccination

Date of Second Vaccination (if applicable)

Please upload your COVID-19 Vaccination Card Here

Please upload your COVID-19 Vaccination Card Here
One file only.
75 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.