Meningitis Record Request-Current and Former Students : Department of Housing and Residential Life : Texas State University

Last Name (Indicate your name when enrolled at Texas State) *

First Name *

Middle Name *

Student Identification Number (A with eight numbers): *

First semester living on campus *

Birthdate *

Student's email *

Cell phone number (with area code) *

I understand that the meningitis record provided to me is a one time only copy. *

Yes

Student Affairs