Arizona State Immunization Information System (ASIIS)

Enrollment Packet

Please read the first five headings below and click on the link to the document that best describes where you work.

To enroll with the ASIIS program, fill out the Enrollment Application and User Agreement, located in each form below. These documents must be mailed in or faxed.

Enrollment Forms

• People who work in a school*
• People who work in a daycare center*
• CPS employees
• People who work in a vaccine provider’s office that USE the free state-supplied VFC vaccine
• People who work in a vaccine provider’s office who DO NOT use the free state-supplied VFC vaccine

*Please fax back all three pages!

Note: Information provided in PDF files, unless otherwise indicated.