Fax (217) 244-1278-2026

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The document outlines the immunization history requirements for students, including necessary vaccinations such as Measles-Mumps-Rubella, Tetanus-Diphtheria-Pertussis, and Meningococcal Conjugate Vaccine. It includes sections for personal information, emergency contact details, and a verification section for licensed health care providers to complete. Additionally, it specifies submission guidelines and deadlines for immunization documentation.

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Click ‘Get Form’ to open the Fax (217) 244-1278 document in the editor.
Begin by entering your Last Name, First Name, and Middle Name in the designated fields. Ensure accuracy for identification purposes.
Fill in your University Identification Number, Home Address, Preferred Phone, and E-mail Address. This information is crucial for communication.
Provide your Date of Birth, Age, and Gender by selecting the appropriate options. This data helps in maintaining accurate records.
Complete the Emergency Contact section with a name, relationship, address, and contact numbers. This ensures that someone can be reached if needed.
For immunization details, ensure that a Licensed Health Care Provider completes the required sections accurately. Attach any necessary documentation as specified.
Review all entries for completeness and accuracy before submitting. Once satisfied, follow the submission instructions provided at the end of the form.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (171 Votes)
2021	4 Satisfied (64 Votes)
2021	4.3 Satisfied (87 Votes)
2020	4.4 Satisfied (68 Votes)
2018	4.3 Satisfied (36 Votes)
2017	4.2 Satisfied (54 Votes)

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Does Illinois require vaccines for school?

Rubella (German Measles) two (2) doses at least 28 days apart. Mumps two (2) doses at least 28 days apart. TD (Tetanus and Diphtheria) three (3) doses required one (1) within past 10 years. Meningitis Required for students under age of 22 Must be given on or after 16th birthday.

What immunizations are required for UIUC?

New Student FAQ. Why do I need to submit immunization forms? The Illinois College Immunization Code requires that college students enrolled on campus should be immunized against diphtheria, tetanus, pertussis, measles, mumps, and rubella. Students under the age of 22 must be immunized against meningitis.

What vaccines are mandatory for college?

Illinois state law requires certain immunizations for children and adults enrolled in child care, school, or college. State law also mandates immunizations for adults in specific fields of work ( e.g., health care). Review these requirements under Laws and Rules.

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Do I need a physical for UIUC?

A licensed health care provider must complete and sign the Immunization History form, or you may attach official immunization records. Is a physical exam required? No, a physical exam is not required for admission.

Fax (217) 244-1278-2026

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