ASIIS Enrollment Packet

Arizona Immunization Program Office

	Please read the first five headings below and click on the link to the document that best describes where you work. In order to view the PDF version, it is necessary to have Acrobat Reader^™ on your machine.
	ASIIS Enrollment Forms People who work in a school [PDF 97K] [DOC 127K] (PLEASE FAX BACK ALL THREE PAGES!) People who work in a daycare center [PDF 96K] [DOC 125K] (PLEASE FAX BACK ALL THREE PAGES!) CPS employees [PDF 96K] [DOC 125K] People who work in a vaccine provider’s office that USE the free state-supplied VFC vaccine [PDF 63K] [DOC 125K] People who work in a vaccine provider’s office who DO NOT use the free state-supplied VFC vaccine [PDF 41K] [DOC 115K] The Law (Arizona Revised Statute (A.R.S. §36-135) The Rule (Arizona Administrative Code (AAC) R9-6-706 and 707)
	To enroll with the ASIIS program, fill out the ASIIS enrollment Application and ASIIS User Agreement. These documents may be mailed or faxed to:
	Arizona Immunization Program Office/ASIIS 150 N. 18th Avenue Phoenix, AZ 85007 (602) 364-3899 (602) 364-3285 (Fax)

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