COVID Vaccine Appointments at TuftsTufts University is partnering with Pelmeds, a Massachusetts based pharmacy, to host the vaccination clinics. Your information will be shared with Pelmeds in order for them to administer the vaccine. The Commonwealth of Massachusetts requires that this information be reported to them after you are vaccinated. If you do not wish to have this information shared with Pelmeds and the Commonwealth of Massachusetts, you should not complete this registration.You must enter the following data to schedule a vaccine appointment. All required fields are marked with an *.*Where are you from?*Where are you from?Tufts UniversityMedford SchoolsSomerville SchoolsCity of MedfordCity of SomervilleOther*Email Address (Tufts email preferred for Tufts students, faculty and staff) Empl ID or Student ID (for Tufts students, faculty, staff)*First NameMiddle Name*Last Name*Birthdate*BirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900*Gender*GenderFemaleMaleTransgenderUnknown/undifferentiatedRaceRaceAmerican Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderOther RaceUnknown/undeterminedWhiteEthnicityEthnicityHispanic or Latinonot Hispanic or LatinoUnknownPhone (XXX) XXX-XXXX*Mailing Address - Please enter a valid US address*Mailing Address - Please enter a valid US addressCountryStreetCityRegionPostal CodeApp Submitted (Hidden)YesNoRound (Hidden)COVID19 VaccineGenerate Pin (Hidden)YesNoProspect Id (Hidden)Source (Hidden)COMDWVACSubmit