Vaccination Intention

1. Directions

If you are choosing not to receive a COVID-19 vaccination or are unsure, please take a moment to confirm your intentions by completing the form below.

Question Title

1. First Name (Required.)

Question Title

2. Last Name (Required.)

Question Title

3. Email (Required.)

Question Title

4. Andrews University ID# (Required.)

Question Title

5. Check the statement below that best applies to you. (Required.)

I do not plan on receiving a COVID-19 vaccination.

Currently, I am unsure if I will receive a COVID-19 vaccination.

Comment (optional):

Vaccination Intention

1. Directions

Question Title

* 1. First Name (Required.)

Question Title

* 2. Last Name (Required.)

Question Title

* 3. Email (Required.)

Question Title

* 4. Andrews University ID# (Required.)

Question Title

* 5. Check the statement below that best applies to you. (Required.)

1. First Name (Required.)

2. Last Name (Required.)

3. Email (Required.)

4. Andrews University ID# (Required.)

5. Check the statement below that best applies to you. (Required.)