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Required Health and Immunization Forms
Please fill out and return these forms. Thank you.
Immunization Information
| Students 17 years of age and younger: |
| DTP or Td |
Polio |
Measles |
Mumps |
Rubella |
|
| 3 |
3 |
2 |
1 |
1 |
|
| Students born 1957 or later and 18 years of age or older: |
| DTP or Td |
Polio |
Measles |
Mumps |
Rubella |
|
| 3 |
0 |
2 |
1 |
1 |
|
| Students born before 1957: |
| DTP or Td |
Polio |
Measles |
Mumps |
Rubella |
|
| 3 |
0 |
0 |
0 |
1 |
|
| Students 50 years of age and older: |
| DTP or Td |
Polio |
Measles |
Mumps |
Rubella |
|
| 3 |
0 |
0 |
0 |
0 |
|
| International Students |
| DTP or Td |
Polio |
Measles |
Mumps |
Rubella |
Tb skin test |
| 3 |
3 |
2 |
1 |
1 |
1 in past 12 months |
1. DTP (Diphtheria, Tetanus, Pertussis), Td (Tetanus, Diphtheria): One Td booster within the last 10 years.
2. Measles: One dose on or after 12 months of age; second at least 30 days later. History of physician-diagnosed measles disease is acceptable, but must have signed statement from physician.
3. Two measles doses if entering college for the first time after July 1, 1994.
4. Mumps and Rubella: One dose of or after 12 months of age. Only laboratory proof of immunity to rubella or mumps disease is acceptable if the vaccine is not taken. History of rubella or mumps disease, even from a physician, is not acceptable.
Recommended Vaccines:
1. Meningitis: North Carolina law requires public and private institutions with on-campus resident to provide information about meningococcal disease. Information regarding the disease and vaccine are below.
2. Hepatitis B: a series of 3
3. Varicella (chicken pox)
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