UIS Voluntary COVID-19 Vaccination Interest Questionnaire

UIS Voluntary COVID-19 Vaccination Interest Questionnaire

The University of Illinois Springfield has been designated as an approved site to deliver the COVID-19 vaccination. Details of when UIS would receive vaccines or how many vaccines we will receive remain unknown, but to help the university properly plan for distribution of this free, voluntary vaccination, please provide the following information expressing your interest in being vaccinated at UIS. This information will be provided to a subgroup of the UIS COVID-19 Rapid Response Team that is developing the university’s voluntary vaccination program.

requiredPrimary status on campus (select one):

requiredPrimary status on campus (select one):

requiredAre you interested in receiving the COVID-19 vaccine at UIS?

requiredAre you interested in receiving the COVID-19 vaccine at UIS?

Please complete the below information if you would like to receive the vaccine at UIS: