Immunization Record Form Immunization Record Form Preview on Page 1

Immunization Record Form Immunization Record Form 2026

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  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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To request an electronic PDF, by mail or by encrpypted email, visit the public health portal. Note: Anyone over the age of 18 must request their own immunization record. An official immunization record is provided in Texas by ImmTrac2 system.
Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.
Why you need your childs vaccine records. It is important to keep your childs vaccination records (the history of which vaccines they received) up to date and in a safe place. Without documentation, your child might not be allowed to attend school, play sports, or travel abroad.
There are two ways to verify immunization history: Vaccination records from health care providers: Confirm when, where and by whom certain vaccines were administered. When these records are unavailable: Results of a blood titer test can provide the documentation that a school or workplace may need.
Immunization information systems (IIS) are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

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Doctors and health clinics keep records of the vaccines they give to your child. Keep in mind that they may save records for only a few years.

Related links

Student Immunization Record

The purpose of this form is to measure compliance with the law and will be used for that purpose only. You may also use the Wisconsin Immunization Registry:

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