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Thank you for your interest to receive a COVID-19 vaccine on campus at Cal State Fullerton. Please complete the following information. We will contact you when a vaccination clinic is scheduled.
Contact Information
Name (first, last)
CSUF Email
Contact Phone Number
What days work best for you? (select all that apply)
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
What time of day works best for you? (select all that apply)
Mornings
Afternoons
Late Afternoons/Early Evenings
Which vaccine option interest you? (select all that apply)
Single Dose (i.e., Johnson & Johnson)
Two Separate Doses (i.e., Moderna and Pfizer)
Thank you.
Dean of Students Office
deanofstudents@fullerton.edu
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