Juneau Icefield Research Program
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Vaccination History
Legal Name
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First Name
Last Name
Preferred Name
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Email
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What is your role on the 2024 Expedition?
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select one
Student
Staff
Teaching Faculty
Research Faculty
Other
Birthdate
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(mm/dd/yyyy)
Vaccination Dates
Tetanus Date
Please provide a month and year. The exact date is not necessary.
Pertussis Date
Pertussis is often given in the same shot as Tetanus, known as "Tdap." Please provide a month and year. The exact date is not necessary.
COVID-19 Date
Please provide the date of your most recent COVID-19 vaccination. Participants are required to have an COVID vaccination (received after September 2023).
Measles, Mumps & Rubella (MMR) Date
Please provide the month and year. The exact date is not necessary.
Hepatitis A Date
The Hepatitis A vaccine is not required, only if you have it for other reasons (work, travel, special concern, etc.). Please provide the month and year. The exact date is not necessary.