Immunization Record Form Immunization Record Form 2026

1. Click ‘Get Form’ to open the Immunization Record Form in the editor.
2. Begin with Part 1: Student Information. Fill in your Last Name, First Name, Empl ID # (an 8-digit number from your CUNYfirst account), Date of Birth, Middle Initial, Daytime Telephone #, and E-mail Address.
3. Proceed to Part 2: Immunization History. Ensure that a healthcare provider completes Parts A & B. In Part A, check off the appropriate boxes for MMR and other vaccinations, providing dates as required.
4. In Part 3: Meningococcal Meningitis, read the instructions carefully. Check one box in Section A regarding your immunization status and sign Section B. If under 18, ensure a parent/guardian signs.
5. Review all sections for completeness and clarity before submitting your form along with any required documentation through the online CUNYfirst Document Uploader.

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