CONFIDENTIAL COVID-19 VACCINATION ATTESTATION FORM – American Film Institute
CONFIDENTIAL COVID-19 VACCINATION ATTESTATION FORM

CONFIDENTIAL
COVID-19 VACCINATION
ATTESTATION FORM

This form is to confirm your COVID-19 vaccination status and will be used only for determining your eligibility to work or learn in-person on AFI’s campus and to participate in off-campus activities sponsored by AFI, including production. AFI will keep this form and its contents completely confidential and will not share it with anyone outside of AFI Human Resources, Fellow Affairs, or COVID Compliance for any reason without your permission. You are free to revoke this form and remove it from AFI’s records at any time. Please contact AFI Human Resources or Fellow Affairs to request revocation and removal of this record.

I am: *

*”Fully vaccinated” means more than two weeks has passed since receiving your one dose vaccine (Johnson & Johnson/Janssen) or your second dose of mRNA vaccine (Pfizer-BioNTech or Moderna ) or other FDA or WHO-approved vaccine.


Picture of vaccine card:

Please follow these steps to attach a picture of your vaccine card:
1) Take a photo of the front of your vaccine card.
2) Click below to attach the photo to this form.

Please ensure your image includes the following details:
• Name of person vaccinated
• Brand of COVID-19 vaccine received
• Date of last dose administered

Maximum upload size: 12MB

I understand the above and agree that the information I am providing is true and correct.

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