Berkshire Community College - Immunization Requirements Template
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1
2IMMUNIZATION
REQUIREMENTS
FOR FOREIGN-BORN STUDENTS
IMPORTANT:
Return completed form to Immunization Records Office (A-100) before the first
day of classes or you may be withdrawn from the college.
To comply with state legislation (Chap. 76, Sec. 15C, General Laws of Mass.), BCC has adopted the
following procedures on student immunizations:
WHO MUST RESPOND?
1. All foreign-born students regardless of number of credits.
WHAT IS REQUIRED?
1. One dose of Tdap if it has been longer than five years since the last dose of Td.
2. Two doses of MMR combination vaccine for Measles, Mumps and Rubella.
3. Three doses of Hepatitis B vaccine.
4. Two doses Varicella.
5. A recent negative Tuberculosis test (or negative chest x-ray within the last five years) for all
foreign-born students upon entering BCC. If chest x-ray is positive, provide treatment schedule.
6. Medical forms from doctor’s offices should include vaccinations in English language, and must
be complete with month, day and year of vaccine.
WHAT PROOF IS NEEDED?
1. The form on the back of this page can be filled out and signed by a medical professional.
Medical forms from doctor’s offices should include vaccinations listed in English and show a
complete date of month, day and year of vaccination.
2. Antibody laboratory blood test (Titer) indicating immunity for Measles, Mumps and Rubella (MMR),
Varicella, and Hepatitis B must be accompanied by the laboratory report.
3. In the event no documentation can be obtained, you must be re-immunized against these
diseases. Contact your personal physician or community health services agency.
Berkshire Community College is an affirmative action/equal opportunity institution and does not discriminate on basis of race, creed, religion, color, gender, gender
identity, sexual orientation, age, disability, genetic information, maternity leave, military service, or national origin in its education programs or employment.
rev. 9/14
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