Assistance Request: COVID Vaccine

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Assistance Request: COVID Vaccine

This form is for students who would like information about locations in MN where they can receive the COVID vaccine. You will be added to a group email list that provides frequent updates (M-F) about where vaccines are available, based upon your vaccine type (Moderna, Pfizer).

* Indicates required question

Name *

Your answer

email *

Your answer

cell phone number *

Your answer

Do you need first or second dose? *

First

Second

Which vaccine did you receive for your first dose?

Pfizer BioNTech

Moderna

Clear selection

Date of first dose *

MM

/

DD

/

YYYY

State where you received your first dose *

Your answer

If you have additional questions or concerns about locating a 2nd dose, you can add that here:

Your answer

Submit

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