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Academics >  Student Services >  Records Request >  Immunization Records Request > 

Immunization Records Request Form

Only to be filled out by transfers and for seniors ADMITTED to college.
Date
 
First Name
Middle Name
Last Name
Class of
School Name
Street
City
State
Zip Code
  

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4575 Lawrenceville Highway, Lilburn, GA 30047 Telephone 770.279.7200 Fax 770.279.8258
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