Due Date: Please complete this survey by August 1, 2021

This form is required for any student who has not yet been vaccinated against COVID-19, has not provided their vaccination records, and has not applied for an exemption.  You do not need to fill out this form if you have already uploaded your vaccine record in Medicat or if you immediately upload your vaccination record.  Instructions for uploading can be found on the Verify your Vaccination page on the Healthy Brown website (https://healthy.brown.edu/vaccinations/verify).

Your responses on this form will help with tracking and communications in advance of the fall semester. As a reminder, Brown is requiring COVID-19 vaccines for all undergraduate, graduate and medical students who will be on campus or engage in any level of in-person instruction this fall.  

This form is secure and confidential.  You can edit this form later if your situation changes. Please reach out to Brown’s COVID-19 support team (studenttesting@brown.edu) if you have any questions.

If you would like to apply for an exemption, you must do so by July 15, 2021.  You can receive further information on applying for exemptions by emailing University Health Services (nursing@health.brown.edu).

Please also know that international students are not expected to arrange their travel around vaccination plans. For more information, please see the Vaccine Availability & Eligibility page on the Healthy Brown website (https://healthy.brown.edu/vaccinations/eligibility).