Vaccination Status of Students (학생 백신 접종 현황-3차 포함)

Dear Parents.

We plan to identify the status of vaccinations for children and adolescents (11-18 years old, Gr.5 ~ Gr.12) students and utilize them for COVID-19 related school attendance and epidemiological investigations in case of a confirmed case.

Please fill out the form and submit it once your child (SIS student) has been vaccinated against COVID-19.

Thank you for your cooperation in responding to COVID-19.

COVID-19 SIS TFT

Parent Cellphone Number *
Student ID Number or Homeroom(ES)
Student ID Number can be found on Powerschool or on the student ID card
Student Date of Birth *

Month Day Year
Student Name *
Student Grade *
1st Vaccination Date *

Month Day Year
2nd Vaccination Date *

Month Day Year
3rd Vaccination Date

Month Day Year
Type of Last Vaccine Shot Recieved (2nd or 3rd) *

Pfizer Moderna Other
Please upload the proof of the last vaccination

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Please upload either a scanned copy of certificate of vaccination or the screen capture of COOV registration
Cancel of
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