Call 765-423-9221, ext. To continue with registration, please click "Add to Cart" . Purdue University Student Health Service (PUSH) – Flu shots are currently available only for students who are minors or who have an already existing appointment to meet the Pre-Matriculation Immunization Review requirements for the state of Indiana. The Purdue University Online Writing Lab serves writers from around the world and the Purdue University Writing Lab helps writers on Purdue's campus. (Vaccination Form) The 4-H member should hand-carry this completed form to all 4-H Horse and Pony Events. PURDUE UNIVERSITY NORTHWEST RESIDENT/STUDENT IMMUNIZATION FORM Please PRINT- This form AND proof of previous immunizations must be completed in ENGLISH and signed by (1) a medical provider and (2) the student (parent or guardian if student is under age 18). ... Be sure to keep all the elements in a list in the same form. Example 1. No sections currently available. 1 to make an appointment with our immunization clinic. ... 2 Indiana law requires rabies immunization be administered by a licensed and accredited veterinarian. If you're interested in Purdue, fill out a request form and get on our mailing list so we can provide you with information. Other immunization records acceptable to the Indiana State Department of Health also may be used to document compliance with the immunization requirements. If there is an outbreak of any of the diseases for which Purdue Fort Wayne requires immunization documentation, university administrators will consult the database of students who claimed exemption, for religious or medical reasons, and will contact you to advise you to leave campus immediately and not return until an “All Clear” is given. Registration Instructions. Johnnie Mae Farm, formed from a partnership between Purdue Extension and the city of Fort Wayne, Ind., is a small, urban farm that provides affordable, fresh produce to a neighborhood that otherwise has limited access to food. ... Purdue on Facebook Purdue on Twitter Purdue on YouTube Purdue on Instagram Purdue on Pinterest Purdue on Snapchat Purdue on LinkedIn Amazon pickup locations at Purdue. Immunization 11 Form. ... Purdue University Office of Admissions, 475 Stadium Mall Dr., West Lafayette, IN 47907, (765) 494-1776, Hearing impaired only: 1-800-743-3333 2. Evidence of immunization or immunity may be documented by completion of the Purdue Health History Form and signed by a healthcare provider. IBEP IMMUNIZATION FORM (This form must be completed and accompany bulls to the Test Station.) Information regarding on-campus influenza events for the regional campuses is available here. 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