Proof of Vaccination Employee Incentive

Spoon River College is committed to the health and safety of our students and employees. Supporting and encouraging the vaccination of employees and students plays a crucial role in a safe Fall 2021 semester and in ending the pandemic. Vaccinated employees help protect co-workers, students, their families, and the community. It also helps the world transition to a post-pandemic future.

Your commitment to your health and the health and safety of others is greatly appreciated. Fully vaccinated employees who provide proof of vaccination are eligible to receive a $300 payment. In order to receive the incentive, you must have both doses of Moderna or Pfizer or a single dose of Johnson & Johnson and provide proof of vaccination.

The payment will be provided through payroll and it will be subject to applicable taxes and deductions. Employees must be actively employed to be eligible.

At this time, eligible employee groups are- Classified Staff, Full-time Faculty, Professional Support Staff, Administrators, and Coaching Staff.

Employee Name: *

Employee Email: *

Vaccine: Product Name/Manufacturer *

1st Dose Lot # *

First Dose Date * +

1st Dose Health Care Professional or Clinic Site *

2nd Dose Lot # *

Second Dose Date * +

2nd Dose Health Care Professional or Clinic Site *

Employee Date of Birth * +

Today's Date * +

Proof of Vaccination - A clear photo of front and back of vaccination card is sufficient. *

Terms/Conditions: You must be a current active employee effective during the 9/18/21-10/1/21 pay period to be eligible. Participation does not guarantee continued or future employment. By checking Agree you agree to the Terms/Conditions. *

Agree

Questions about this form? Contact Katey Davis.