UNH Student Flu Notification Form


First Name*:  
Middle Initial:
Last Name*:  
StudentID*:    
Cell Phone*:    
Email Address*:    
Undergraduate/Graduate:
If athlete, please select sport(s):    
Resident/Commuter*:
List any medications you are allergic to:
  Symptoms*:


Did you get a flu vaccine this year?:
To verify human entry, please enter the text you see in this image: