Covid-19 Vaccination Verification (Employee)

Covid-19 Vaccination Verification (Faculty & Staff)
Please enter your name and email address and upload your Covid-19 Vaccination card here. This information is confidential: the record will be maintained by the Human Resources office and your vaccination status will only be shared internally when necessary. Please contact hr@uwest.edu if you have any questions.
Your Name*

First NameLast Name
Your UWest Email*
example@example.com
Upload a clear image of your vaccination card here (.pdf, .jpg, .png)*

Cancelof
I certify that the attached image is a true copy of my authorized Covid-19 vaccination card and accurately reflects my vaccination status.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Covid-19 Vaccination Verification (Faculty & Staff)