Mandatory Immunization Health History Form printable pdf download

IMPORTANT IMMUNIZATION REQUIREMENTS

PLEASE READ CAREFULLY

As a University of Florida English Language Institute student you are required to have

documentation of specific immunizations on the enclosed UF immunization form. You will miss

valuable class time if you wait to obtain your immunizations in the U.S. You will save time and

money if you have a doctor in your country verify your immunizations, or if you can have

them administered in your country BEFORE arriving at the ELI.

Required Immunizations:

MMR (Measles/Mumps/Rubella)

 Must have received 2 doses of MMR.

 First MMR dose must have been administered after your first birthday. The second MMR

dose must have been administered after 1985.

 There must be at least 1 month between MMR doses.

PPD (Tuberculosis Skin Test)

 Must have been conducted within the past year of the semester you wish to attend.

 The PPD test cannot be administered directly after a MMR dose; a minimum of one month

must pass. It is acceptable to receive an MMR injection and a PPD test on the same date.

 Please note that the University of Florida DOES NOT accept BCG vaccine as a PPD.

 If the PPD is positive, the reaction’s measurements must still be noted and you must provide

a copy of the x-ray report in English.

Optional Immunizations:

Meningococcal Meningitis and Hepatitis B

 These are not mandatory immunizations; if you choose not to have these optional

immunizations then you must sign and date the waiver at the end of section A on the UF

immunization form (on the right side).

If you are under the age of 18, a parent or legal guardian must sign and date the areas on the UF

immunization form.

 Section A (right side)

 Section F

Correspond only with the English Language Institute about your immunizations. Please DO NOT

fax your completed form to the Student Health Care Center.

If you have any questions or concerns about these requirements please contact the Admissions

Coordinator at the English Language Institute at the University of Florida.

Admissions Coordinator: Daryl Bish

Email:

StudyEnglish@eli.ufl.edu

Phone: + (1) 352-273-4392

Fax: + (1) 352-392-3744

Mandatory Immunization Health History Form