Clic here to download the Immunization History Form

State law requires all degree and full-time non-degree college students born after December 31, 1956, to provide proof of immunization or immunity to the following diseases:

* Tetanus/diphtheria vaccine within the last ten years.  Students must be re-immunized if the tetanus is out-of-date.

* Two doses of the Measles, Mumps, Rubella vaccine after the student’s first birthday.  If the vaccine was administered prior to 1968, you must present laboratory results of your titer tests.  If immunization cannot be determined, re-immunization is required.

Required immunizations for health career students include the two doses of the Measles-Mumps-Rubella (or titer showing immunity), one dose of the Tetanus/Diphtheria (administered within the last ten years); two doses of the Varicella vaccine (or titer showing immunity); Hepatitis B series (series of three doses given at appropriate intervals); and Mantoux test for Tuberculosis (two-step administered initially, with yearly follow-up while enrolled).

The Immunization History Form and accompanying immunization records are kept on file for five years after the last date of attendance. After five years, the form and immunization records will be shredded.

Questions concerning immunization dates and records should be directed to Rebecca Mallett. They can be reached at 207.974.4715 or by email at