Hcc meningitis vaccination verification form 2025

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  1. Click ‘Get Form’ to open the hcc meningitis vaccination verification form in the editor.
  2. Begin by entering your Last Name and First Name in the designated fields. Ensure that the names match your official documents for accuracy.
  3. Fill in your Date of Birth, ensuring you use the correct format as specified on the form.
  4. Input your HCC Student ID Number, which is essential for processing your submission.
  5. Provide your Daytime phone number and Email address for any follow-up communication regarding your submission.
  6. Select one of the options regarding your meningitis immunization documentation: either submitting documentation, a medical exemption affidavit, or an affidavit for exemption from immunization for reasons of conscience.
  7. Read and confirm that you understand the Bacterial Meningitis immunization requirement by checking the appropriate box.
  8. Sign and date the form electronically to certify that all information provided is true and correct before submitting it through your preferred method.

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If you arent sure whether your teen or young adult has received meningitis B vaccination, contact their healthcare providers office and ask for your childs vaccination records. If records confirm they havent received meningitis B vaccination yet, bring it up at the next doctor visit.
Students in public institutions of higher education must be immunized against Tdap, MMR, meningococcal disease and hepatitis B. A religious exemption is permitted. Public and private colleges that offer on-campus or group housing must provide information on meningococcal disease to each first-time student.
A form with the signature or stamp of a physician, designee, or public health personnel with the agency name and address; which documents when (month, date, four-digit year) the vaccination or booster was administered. An official immunization record generated from a state or local health authority.
All children ages 11 through 12 years should receive the MenACWY vaccine followed by a booster dose at age 16 years. Catch-up vaccination is also recommended for all adolescents ages 13 through 18 years of age who did not receive a dose at 11-12 years of age.
The meningococcal conjugate vaccine (MenACWY) protects against four types of meningococcal bacteria (types A, C, W, and Y). It is recommended for all kids and teens age 11 and older.
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Provide information about a students past immunization for meningitis, or confirm that the student will not be immunized. If student is a minor, you can also use this form to provide consent for general medical treatment by Student Health Services.
The bacterial meningitis vaccination expires five years after the date it is received. The vaccination must be within the five years on the first day of classes for the semester starting.

meningitis vaccine certificate pdf