Immunization Online Self-Report

If you would prefer to turn in a hard copy of the immunization report, you may download a copy of the report form here, and turn in the report by secure upload, fax, or in person.

If you have any questions, please contact the Office of Registration and Records.

Address: Parsons Hall Room 009
Phone: 812-237-2020
Fax: 812-237-8039
Secure Upload:

Please log in to submit Immunization Self-Report Form


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Mailing Address:

Office of Registration and Records
Parsons Hall Room 009
Indiana State University
Terre Haute, IN 47809


(812) 237-2020


(812) 237-8039


Walk-in Office Hours:

Monday 8:30 a.m. - 4:30 p.m.
Tuesday 8:30 a.m. - 4:30 p.m.
Wednesday 8:30 a.m. - 4:30 p.m.
Thursday 9 a.m. - 4:30 p.m.
Friday 8:30 a.m. - 4:30 p.m.

Phone lines available:

8 a.m. - 4:30 p.m. MTWF
9 a.m. - 4:30 p.m. R