Student Immunization History Form

New York State Public Health Laws 2165 and 2167 and/or New York University requires that all newly admitted students (graduate, undergraduate and transfers) taking six or more credits in a degree-granting program must comply with the following immunization requirements.

Failure to meet New York State and NYU mandated immunization requirements will result in de-enrollment and denial of access to Residence Halls on your scheduled move-in day (if you are planning to live on campus). De-enrollment means: a) you will be "dropped" from classes that you have registered for and will no longer be enrolled in or able to attend your classes; and b) you will be excluded from entering campus buildings. Your student ID card may also be deactivated.

MMR (Measles, Mumps and Rubella) - Must provide one of the following to comply with this requirement:*

• Certification from a health care provider or other acceptable evidence that you have received two MMR vaccines.
• Or evidence of immunity by history of disease for measles or mumps only and proof of immunity by vaccination or blood test to Rubella
• Or serological evidence for Measels, Mumps and Rubella (blood test proving immunity)

* Students born before January 1, 1957 are exempt from this requirement.

Meningitis** - All newly admitted undergraduate students must provide evidence of vaccine for Meningococcal Meningitis.

A physician's signature is required on the Student Immunization History Form. The Student Immunization History Form is a paper form that is mailed to all new students. Please return before the following deadlines:

• For the Spring semester: December 15
• For the Summer semester: May 15
• For the Fall semester: August 15

** If you are over the age of 21 and NOT living in a dorm, you may petition to be excluded from this requirement by completing the Meningitis Response Form (PDF).