What Is a Student Health and Immunization Record?
The Student Health and Immunization Record is a form that you and your healthcare provider must fill out and provide to the university’s Student Health Center before you can attend Stevens. Every graduate and undergraduate student must meet this requirement.
Your record remains confidential and only needs to be completed once, upon your entrance to the university. This record serves two purposes:
- It becomes your personal medical record, and allows the Student Health Center to provide you with medical care based on your personal health needs.
- It certifies that you have received the minimum vaccinations required to attend a state-accredited university, as mandated by New Jersey state law (N.J.A.C. 8:57-6).
DOWNLOAD THE FORM
Which Immunizations Are Required?
To comply with State of New Jersey legal requirements and Stevens requirements, full-time students must be immunized with:
- Two doses of Measles vaccine.
- Two doses of Mumps vaccine.
- Two doses of Rubella vaccine.
- One dose of Meningitis vaccine if residing in campus- owned or leased housing. Booster required if last vaccination was before 16th birthday.
- Three doses of Hepatitis B vaccine (which completes one series of the vaccine).
- Tuberculosis (TB) test prior to the first 6 months of enrollment.
- Two doses of Varicella vaccine or date of actual disease of chickenpox documented by primary care physician
- Additionally, Stevens requires a recent physical examination to be documented in your Student Health and Immunization Record (within the last school year).
- All Student Health and Immunization Records must be in English including vaccinations as per NJ State law.
- One dose of Tetanus/Diphtheria or TDAP.
- Two doses of Hepatitis A.
When Is It Due?
The deadline for submitting your Student Health and Immunization Record form is July 13.
The form must be completed in full, signed, dated and stamped by a physician or healthcare provider. Be sure to make an appointment with your provider far enough in advance to meet the deadline.
How Do I Submit It?
By mail:
Student Health Center
Stevens Institute of Technology
1 Castle Point on Hudson
Hoboken, NJ 07030
By email: [email protected]
By fax: 201-216-5677
What Happens If I Don’t Submit It?
A hold will be placed on your student account if we do not receive your completed Student Health and Immunization Record. This means you will not be able to register in person or via the web for any future classes until all forms are received by the Student Health Center.
What If I Need an Immunization Exemption?
The form allows you apply for an exemption from immunizations due to immune status, age, medical reasons or religious reasons. Documentation must be provided in order for the university to grant an exemption. You must still complete the form, regardless of an application for an exemption, and submit it in full by the deadline.
DOWNLOAD THE FORM
Questions?
Student Health Center
First Floor of Jacobus Hall
1 Castle Point on Hudson
Hoboken, NJ 07030
p. 201.216.5678
e. [email protected]
f: 201.216.5677
