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The document is an Immunization Form required by Florida Atlantic University (FAU) for students prior to registration. It outlines mandatory immunization requirements for Measles, Rubella, Meningococcal Meningitis, and Hepatitis B, along with acceptable documentation for compliance. The form must be completed and submitted to the FAU Immunization Office, and students are informed about potential exemptions and the importance of vaccinations. Additional information regarding health services, insurance, payment methods, and confidentiality of medical records is also provided.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name, student ID number, and birth date. Ensure all details are accurate.
In Section A, provide documentation of your immunizations for Measles and Rubella. You can either upload proof of vaccination or indicate if you have a signed waiver.
For Hepatitis B and Meningococcal Meningitis in Section B, follow the same process as above. Make sure to include dates of vaccinations or waivers where applicable.
Complete Section C with any additional recommended immunizations. This section is optional but beneficial for your health records.
Finally, ensure that the form is signed by you and an authorized physician. Don’t forget to add the office stamp for validation before submitting.

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Mail Fax this form to: 2026

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