... Purdue University Office of Admissions, 475 Stadium Mall Dr., West Lafayette, IN 47907, (765) 494-1776, Hearing impaired only: 1-800-743-3333 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. Immunization 11 Form. 1 to make an appointment with our immunization clinic. No sections currently available. Call 765-423-9221, ext. 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.) Other immunization records acceptable to the Indiana State Department of Health also may be used to document compliance with the immunization requirements. (Vaccination Form) The 4-H member should hand-carry this completed form to all 4-H Horse and Pony Events. ... Be sure to keep all the elements in a list in the same form. Other immunization records acceptable to the Indiana State Department of Health also may be used to document compliance with the immunization requirements. IBEP IMMUNIZATION FORM (This form must be completed and accompany bulls to the Test Station.) 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. 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). 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. 2. The Purdue University Online Writing Lab serves writers from around the world and the Purdue University Writing Lab helps writers on Purdue's campus. Example 1. Evidence of immunization or immunity may be documented by completion of the Purdue Health History Form and signed by a healthcare provider. If you're interested in Purdue, fill out a request form and get on our mailing list so we can provide you with information. ... 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. ... 2 Indiana law requires rabies immunization be administered by a licensed and accredited veterinarian. Information regarding on-campus influenza events for the regional campuses is available here. To continue with registration, please click "Add to Cart" .