Student Immunization Form

Immunizations

WE ARE OBLIGATED BY VERMONT SCHOOL IMMUNIZATION REGULATIONS TO CERTIFY IMMUNIZATION OF NEW STUDENTS.

A student is not required to have any immunizations that are medically contraindicated. A signed statement from a licensed physician that an immunization is medically contraindicated for a specified period of time and the reasons for the medical contraindicated will exempt a student from the specific immunization.

A student is exempted from the immunization requirements if the student (or the parent or guardian of the student if the student is under 18 years old) objects in a signed statement that the proposed immunization interferes with the free exercise of the student's religious or moral rights.

We are assuming that most students have already received these immunizations. This request merely documents these immunizations for the corresponding disease.

TDAP (Tetanus, Diphteria, and Pertussis)

All students who are without an exemption from immunization must have received:

  • One dose of TDAP (tetanus, diphtheria, and pertussis) vaccine or one dose of Td (tetanus and diphtheria) vaccine within the past ten years (Tdap preferred).

MMR (Measles, Mumps, and Rubella)

All students who are without an exemption from immunization must have received:

  • Two doses of MMR (measles, mumps, and rubella) vaccine, or
  • Physician-diagnosed measles, mumps, and rubella disease.

HEPATITIS A

New England Culinary Institute strongly suggests that all students who are without an exemption from immunization to receive:

  • Two doses of Hepatitis A vaccine with at least 6-12 months separating doses.

HEPATITIS B

All students who are without an exemption from immunization must have received:

  • Three doses of Hepatitis B vaccine.

CHICKENPOX (Varicella)

All students who are without an exemption from immunization must have received:

  • Two doses of chickenpox (varicella) vaccine or documentation of disease. A health department form is required to document disease and is available at the State of Vermont Healthcare website.

MENINGOCOCCAL VACCINE

All students who are without an exemption from immunization must have received:

  • One or two doses of meningococcal vaccine (required only for first year students living in dormitories who are not older than age 21). If vaccinated before the 16th birthday, a second dose is needed before college entry.