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

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

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