COVID Vaccination Registration Form

Thanks to the generous partnership with University Medical Center, all EPISD employees now have a dedicated registration portal for the COVID-19 vaccine. Registration through this site is for EPISD employees only. All information is confidential and secure. Please do not register here if you have already secured an appointment elsewhere. You will be contacted for an appointment between the hours of 7:00 a.m.- 9:00 p.m. UMC will call to set up appointments. Please do not call UMC directly. For questions, please email covid19request@episd.org

Employee Last Name*

Employee First Name*

Assignment Location*

Select

Position*

Select

Contact Phone Number*

Employee email address*

Must be a district issued email address e.g. johndoe@episd.org

Please upload both COMPLETED registration forms.*

IMPORTANT NOTE: The contact phone number listed on the form should be the best number that you can be reached between the hours of 7:00 a.m. - 9:00 p.m. as UMC will use this number to schedule your appointment.

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