1 Schools of Higher Learning) 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Social Security Number and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for your records.
3. Next, fill in your full name (Last, First, Middle) and address details including City, State, and ZIP Code. This helps the university identify you correctly.
4. Proceed to the 'University Required Immunizations' section. Indicate your vaccination status for M-M-R (Measles, Mumps, Rubella) and Tetanus-Diphtheria by providing dates and results where applicable.
5. For the Meningococcal Vaccine, enter the date received and type of vaccine. If you are requesting an exemption, ensure to check the appropriate box and provide a reason.
6. Finally, have your physician or health care provider sign and date the form. Make sure their office address or stamp is included for verification.

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