COVID Vaccination Affirmation Report Form 2021-2022 School Year
Pursuant to 10 NYCRR 2.62 and the NYSDOH Commissioner of Health request regarding weekly testing or vaccination status. On a weekly basis, all staff of (P-12) schools in NYS must provide the following information to the employer/District effective September 2, 2021.
PLEASE NOTE: You are not required to receive the vaccine at this time. Providing this information is not a violation of HIPPA and choosing not to answer will result in you being considered "unvaccinated".
Please respond to report your vaccination status by completing this form.