Wufoo
On-Campus Vaccine Standby Notification
LMU is hosting a COVID vaccination clinic for LMU staff, faculty, and students. Due to canceled appointments and no-shows, we often have extra doses available each afternoon. If you want to be notified in the event that doses become available, please submit the form below and a representative will call you when there is availability. Please note that we will contact you from an unlisted number between 11 a.m. - 2 p.m. with the expectation that you can arrive on campus by 2:30 - 2:45 p.m.
Name
*
First
Last
Email
*
Cell Phone Number
*
###
-
###
-
####
Affiliation (choose the one that best describes you)
*
LMU Staff
LMU Faculty
LMU Student
LMU Campus Resident
Employed by Another School/University
Family Member
Other
If not affiliated with LMU, please list the school at which you are employed:
Do Not Fill This Out
This site is protected by reCAPTCHA Enterprise and the Google
Privacy Policy
and
Terms of Service
apply.