ImmunizationsMedical Services - San Jose State University 2026

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The document outlines the immunization requirements for incoming students, detailing necessary vaccinations and serological proof of immunity for Measles, Mumps, Rubella (MMR), Varicella, Tetanus, Diptheria, Pertussis (Tdap), and Hepatitis B. It specifies the number of doses required, the need for serology tests with results, and instructions for additional vaccinations if immunity is not confirmed. The document also includes sections for recording immunization dates and clinician certification.

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Click ‘Get Form’ to open the Immunizations Medical Services form in the editor.
Begin by entering your name and student ID number at the top of the form. Ensure that your email address is also filled out for any follow-up communications.
For each immunization requirement, provide the necessary details. Start with MMR: indicate the dates of your vaccinations and attach any required serologic proof of immunity.
Continue with Varicella, Tdap, and Hepatitis B sections. Fill in the dates for each dose received and include any titer results as specified.
Finally, ensure that a clinician's signature is included at the bottom of the form, certifying that all information provided is accurate.

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2025	4 Satisfied (34 Votes)
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2023	4.5 Satisfied (26 Votes)
2023	4.6 Satisfied (34 Votes)

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