Return completed Immunization Record to: 2025

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  1. Click ‘Get Form’ to open the Immunization Record in the editor.
  2. Begin by entering your full name in the 'STUDENT NAME' field at the top of the form.
  3. For each immunization listed, provide the required documentation. This includes dates and dosages for Measles, German Measles, Mumps, Varicella, Poliomyelitis, Diphtheria, Tetanus & Pertussis, Tetanus and Diphtheria, Hepatitis B, Tuberculosis (PPD), and Influenza.
  4. Ensure you include test results where applicable. For example, document positive titers for Measles and Hepatitis B if immunizations are not available.
  5. At the bottom of the form, obtain a physician or authorized signature along with their license number or office stamp to validate your record.
  6. Once all fields are completed accurately, save your document and prepare it for submission.

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Exemption is permitted with proof of immunity, non-medical exemption or birth before 1957. First-time enrollees at California State University and University of California must show proof of hepatitis B vaccine. All institutions with on-campus housing must provide information about meningococcal ACWY and B.
First-time enrollees at California State University and University of California must show proof of hepatitis B vaccine. All institutions with on-campus housing must provide information about meningococcal ACWY and B. Exemptions for personal beliefs are permitted.
Most schools keep vaccination records on file. Schools may keep records for a year or two after a student leaves or graduates. Contact your childs school for more information.
If your doctor has proof of your immunization history, this may be your preferred option. If you went to high school in the United States, it is very likely your records are on your high school transcript. If you already have these records, check and see if your immunization history is there!
This certificate program does not require renewal.

People also ask

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.

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