The Equity Project (TEP) Charter School - Proof of COVID-19 Vaccination
Please complete this form to submit your proof of COVID-19 Vaccination.
Today's Date
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Month
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Day
Year
Date
Full Name
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First Name
Last Name
Email
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example@example.com
Position
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Campus
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Early Childhood
Elementary School
Middle School
OneTEP
Date of First Dose
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Month
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Day
Year
Date
Date of Second Dose (if applicable)
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Month
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Day
Year
Date
Vaccine Provider
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Pfizer
Moderna
Johnson & Johnson
Uploadan image of your COVID-19 vaccine card or an image of your New York State Excelsior Pass.
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