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Get Fort Valley State University Certificate

Dress Street Date of Birth / / City M State F Zip SSN/Student ID# / / Part II- To be completed and signed by your Health Care Provider Required Immunizations A. Measles, Mumps, Rubella: Required for students born in 1957 or later. Dose 1 Dose 2 Laboratory/serologic evidence of immunity 1. M.M.R. (Measles, Mumps, Rubella) /.

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