Contact and Mailing Information 

Thank you for participating in the Immunize Washington Recognition Program!

First, please run your Coverage Rate Reports from the Washington State Immunization Information System (IIS) using the instructions provided. Coverage Rate Reports should be sent to

Once your Coverage Rate Report has been sent, please fill in the form below to confirm your nomination.

For more information, including the instructions for running the Coverage Rate Report, please visit this website

You may submit nominations for multiple locations using one form, if doing so, please note that all of the certificates and window clings will be mailed to the main mailing address.  

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* Please list the best contact person for any questions regarding the nomination.  

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* Please provide the following contact information for the clinic. Please note, this address will be used to mail the certificate and window clings for all locations.  

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* How did you hear about the Immunize Washington Recognition Program?

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* Are you interested in participating in future immunization quality improvement activities with potential community partners?