Certificate Of Immunization Form Page 2
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2IMMUNIZATION REQUIREMENTS
(EFFECTIVE SPRING SEMESTER 2005)
According to the policies of the Board of Regents of the University System of Georgia, applicants who have not previously
attended Dalton State College must submit proof of all required immunizations certified by a health official.
The Board of Regents and the Division of Public Health of the Georgia Department of Human Resources developed the
requirements and recommendations outlined in the tables below. The following immunizations are required of all new
applicants to Dalton State College effective Spring Semester 2005.
Applicants MUST SUBMIT ONE OF THE FOLLOWING in order to document proof of required immunizations. No other
documentation will be accepted.
•
•
Dalton State College Certificate of Immunization
Georgia County Health Department Immunization History Printout
•
•
Georgia Registry of Immunization Transactions and
Georgia Department of Human Resources Certificate of
Services (GRITS)
Immunization (Form 3231)
•
World Health Organization (WHO) Certificate of
Immunization
PROOF OF IMMUNIZATION OR NATURALLY-ACQUIRED IMMUNITY – REQUIRED
Vaccine
Requirement
Required for:
Measles (Rubeola)
Two (2) doses of live measles vaccine (combined measles -
Student born in 1957 or later
mumps -rubella or “MMR” meets this requirement), with first
dose at 12 months of age or later and second dose at least
28 days after the first dose
or
Laboratory/serologic evidence of immunity
Mumps
One (1) dose at 12 months of age or later (MMR meets this
Student born in 1957 or lat er
requirement)
or
Laboratory/serologic evidence of immunity
Rubella (German Measles)
One (1) dose at 12 months of age or later (MMR meets this
Student born in 1957 or later
requirement)
or
Laboratory/serologic evidence of immunity
Varicella (Chicken Pox)
One (1) dose at 12 months of age or later but before the
All Students
th
student’s 13
birthday,
or
th
If first dose given after the student’s 13
birthday:
Two (2) doses at least 4 weeks apart
or
History of varicella disease (chicken pox)
or
Laboratory/serologic evidence of immunity.
Tetanus, Diphtheria
One TD booster dose within 10 years prior to matriculation.
All Students
Recommendation: Students who are unable to document a
primary series of three (3) doses of tetanus-containing
vaccine (DtaP, DTP, or Td) are strongly advised to
complete a three-dose primary series with Td.
Hepatitis B
Three (3) dos es of hepatitis B series (0, 1-2, and 4-6
Required for all students who will be 18 years of age or
months)
less at time of expected matriculation.
or
Three (3) doses of combined hepatitis A and hepatitis B (0,
Recommendation: It is strongly recommended that all
1-2, and 6-12 months)
students, regardless of their age at matriculation,
discuss hepatitis B immunization with their health care
or
Two (2) doses of hepatitis B series of Recombivax (0 and 4-
provider.
6 months, given at 11-15 years of age)
or
Laboratory/serologic evidence of immunity or prior infection.
Revised 10/2004
ADDITIONAL IMMUNIZATION RECOMMENDATIONS – NOT REQUIRED
Vaccine
Recommendation
Meningococcal quadrivalent polysaccharide vaccine
One (1) dose within 5 years prior to matriculation
Influenza
Annual vaccination at the start of influenza season (October-March)
Hepatitis A
Two (2) doses of hepatitis A series (0 and 6-12 months),
or
Three (3) doses of combined hepatitis A and hepatitis B series (0, 1-
2, and 6-12 months)
Other Vaccines
Other vaccines may be recommended for students with underlying
medical conditions and students planning international travel.
Students meeting these criteria should consult with their physicians
or health clinic regarding additional vaccine recommendations.
Dalton State College is an Equal Opportunity Institution and is a Four-Year Unit of the University System of Georgia
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