DOH Logo Color Web

Immunization Status Report Registration CONTACT INFORMATION CHANGE REQUEST

Complete this form only to change your contact information you entered when you registered to use Washington State's Immunization Information System to submit your annual School Immunization Status Report.

 

Please do not use this form to register or to request access to the system to review student immunization records. See below for contact information. 

 

Step 1. Please enter the information YOU ENTERED WHEN YOU FIRST REGISTERED, so we can find your account. 


First Name:
Last Name:
Email Address:
emailaddress@xyz.com
School District:
School Name:
Username:

Select your school type:
Public
Private

Step 2. Please enter any of your contact information form above that you want to change. Leave the field blank if the information is the same as above.

 
New email:
 

50 characters left.
New USERNAME:
 

50 characters left.

New School District: 

 

50 characters left.
New School:
 

50 characters left.
Enter any other information to change:
 

350 characters left.

 

Questions?
Email us: OICPSchools@doh.wa.gov

 or

 Visit our School Reporting Webpage for more information