ATC Student Vaccination Incentive Verification

Student Vaccination Incentive Verification

I certify that I am fully vaccinated for COVID-19. Fully vaccinated is defined as having received: One dose of the Johnson & Johnson's Janssen vaccine, OR two dose series of the Pfizer or Moderna vaccines.(Required)
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I understand that falsification of vaccination information submitted may result in disciplinary action.(Required)
I understand the incentive will be distributed through BankMobile.(Required)
I understand the incentive payout date is based on the date I submit my Student Vaccination Verification Incentive form. I have read the Incentive Payout Timeline provided.(Required)
Submission deadline date: January 31, 2022 / Incentive payout date: February 28, 2022
I understand my response to this form will be accessed only by authorized individuals to process the incentive payout. I also understand this information will be maintained and stored securely to produce for audit verification purposes.(Required)
I certify that I understand and have answered all questions above truthfully.(Required)