Student Health Services

Student Immunization Form

Student Immunization FormThe Student Immunization Form must be filled out and turned into the Student Health Services on campus. The information is required by Minnesota Law (Minn. Stat. 135A.14): requires students enrolled in a public or private post-secondary school in Minnesota be immunized against measles, mumps and rubella. All doses of vaccine must have been received after the age of 12 months. Also students must be immunized against tetanus and diphtheria. The most recent vaccination must have been within the last ten years.

Students have one semester to comply with this law. If an immunization form is not completed and turned in, a registration HOLD will be placed on the student's record. Students will not be able to register for classes until this information is turned in. If a student qualifies for an exemption: Students are exempt if they were born before 1957 or graduated from a Minnesota high school after 1996. Students are exempt if they are enrolled in only one class or enrolled only in extension classes, they must still turn in an immunization form to Health Services with the appropriate exemption marked.

Download a pdf versoin of the Student Immunization Record Form (PDF 2 pages/29KB)

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