Student Registration for the H1N1 Vaccination (PITTSBURGH CAMPUS)

Please complete the required fields below and click Submit to register for the H1N1 vaccination.

First Name:

Last Name:

This is the 15-character identifier which can be found on the front of your Pitt ID just beneath your name.

Pitt ID Number: 2P

Please enter a telephone number where you can be reached if University personnel need to contact you.

Telephone:

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Please enter your official University of Pittsburgh email address in the format username@pitt.edu.

Email: