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Bacterial Meningitis Vaccination form - The University of Texas at - utdallas

Bacterial Meningitis Vaccination form - The University of Texas at - utdallas 2025

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The document is a Meningococcal Meningitis Vaccine Requirement Form for students at the University of Texas at Dallas. It outlines the necessity for students to provide proof of vaccination against bacterial meningitis before checking into university housing, including options for waivers based on medical or religious grounds. The form includes sections for personal information, parental consent for minors, and documentation of vaccination or waiver status, along with educational information about meningococcal disease and vaccine details.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Section A. Enter your UTD I.D. number, name (last, first, middle), and student status by checking the appropriate box.
Provide your address, birth date, phone number, and email. Ensure all information is accurate and legible.
If you are under 18, complete the Parental/Representative Permit section by having a parent or guardian print their name, sign, and indicate their relationship to you.
In Section B, document your meningitis immunization details. Include the date of vaccination and check any applicable boxes regarding included documentation.
If opting for a waiver in Section C, review the information on the reverse side of the form and provide your signature along with any required documentation.

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Is the meningitis vaccine required for college in Texas?

A Texas State law states ALL new students under the age of 22 must show proof of meningococcal vaccination within the last 5 years and at least 10 days prior to the first class day.

Which meningitis vaccine is required for college in Texas?

Bacterial Meningitis: Only a quadrivalent vaccine or pentavalent vaccine meets the requirement. Meningitis B vaccines do not meet the requirement. The vaccine must be administered within five years of, and no later than ten days before, the first day of classes for the semester a student enters UT Austin.

Is meningitis A or B vaccine for college students?

It is important for students ages 16 to 23 who are planning to go to college or currently in college, to have a conversation with their health care provider about receiving the MenB vaccine. Anyone who has been fully vaccinated against MenB, would only need a single booster dose in the case of an outbreak on campus.

What meningitis vaccine is required for UTD?

Acceptable forms of the vaccination include Meningococcal Conjugate Vaccine (MenACWY), Meningococcal Conjugate Vaccines (MCV) or MenQuadfi. Meningitis B vaccines do not meet the requirement and is not a replacement for the meningococcal conjugate vaccine (MenACWY).

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