Health Services Immunization Form Page 2
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1
2HEALTH SERVICES
IMMUNIZATION FORM
Please return this form to
the Health Center.
Immunization Policy:
As a prerequisite to registration, the State University System of Florida
requires all students born after December 31, 1956 to present documented
proof of immunity to Measles (Rubeola) and German Measles (Rubella).
Completed forms may be faxed to (407) 823-3135.
Proof includes this form, properly completed, stamped and signed by your
qualified health care provider OR records from health departments, health
care offices or school records attached to this form.
Health Services
Acceptable Proof Consists of the Following:
The UCF Health Center is located on the main campus,
1. Proof of two (2) vaccinations (doses) of MEASLES received at
Building # 127, next to Chemistry and Biological Sciences buildings.
least 28 days apart and one vaccination of RUBELLA.
2. Vaccinations MUST have been received AFTER your first
MMR Vaccinations and IGG Titers are available (for a fee) at the
birthday.
Health Center. For an appointment, call (407) 823-3850.
3. Vaccinations MUST have been received in 1968 or later.
4. Proof of immunity by way of a blood test lab result (IGG Titer).
Questions about acceptable proof, exemptions or
Exemptions:
temporary deferments may be directed to the
1. Students born prior to January 1, 1957 are not required to
Immunization Department of
complete the vaccination section of this form. Please complete
the student information and return to the Health Center.
Health Services at
2. Religious exemption (accompanied by written documentation
(407 )823-3707 or 1 (800)613-8544
on church letterhead, signed by clergy).
3. Medical exemption (accompanied by specific, written
documentation on office letterhead, signed by a physician).
Temporary Deferments:
(Must be submitted on office letterhead, signed by a physician)
THIS FORM IS MANDATORY!
1. Pregnancy or possibility of pregnancy
2. Breastfeeding
YOU WILL NOT BE ALLOWED TO REGISTER WITHOUT
3. Illness
PROOF OF IMMUNITY OR EXEMPTION.
FAILURE TO HAVE ALL REQUIRED DOCUMENTATION
HOUSING STUDENTS:
SUBMITTED IN ADVANCE MIGHT SIGNIFICANTLY
Once you receive the Hepatitis B & Meningitis Waiver Form, please be sure to
COMPLICATE AND DELAY YOUR REGISTRATION!
forward it to Housing & Residence Life Department, NOT the Health Center.
Revised:02/22/06
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