Forms

Immunizations and Vaccinations

Please review the Immunization and Vaccination Requirements before submitting any of the following forms.

If you need official copies of vaccination records, see the CDC's How to Locate Your Vaccination Records webpage.

• COVID-19 Vaccination Documentation Form
  Students and employees should use this form to submit documentation of their COVID-19 Vaccination Record.
• MMR Immunization Form (PDF)
  This form should be completed by the student's healthcare provider. New York State law requires that all students born on or after January 1, 1957, and who enroll in six or more credits for any given term must provide proof of immunity to measles, mumps and rubella (MMR). 
• Recommendations for Immunizations and TB Testing for Health Science and Education Students (PDF)
• Request for Exemption from Vaccination/Immunization
  Required for any student seeking to submit a medical and/or religious waiver from NYS immunization and vaccination requirements.
  • Medical Exemption Request Form (PDF)
  • Religious Exemption from Vaccination Request Form (PDF)
• Meningitis Self-Reporting Form (PDF)
  Students also are required by New York State law to have a meningitis response form on file. This is simply a requirement for a signed form; an immunization is not required. Read more about meningitis.

Physicals

• Health Science Physical Form (PDF)
  Required for students in the following programs: Early Childhood and Health Science Students, including: Dental Hygiene, Diagnostic Cardiac Sonography, Diagnostic Medical Sonography, Invasive Cardiovascular Technology, Mortuary Science, Nursing, Paramedic, Respiratory Care, Radiologic Technology and Surgical Technology.
• Athletic Preparticipation Physical Evaluation History Form (PDF)
  Required for all student athletes.

Other Forms

• Authorization for Disclosure (PDF)
  Permits the college to release immunization, treatment, laboratory and physical exam records as necessary.
• Documentation of COVID-19 Test Results
  Students and employees should use this form to submit documentation of their COVID-19 test results, including clearance from county health departments.

When Being Seen/Treated in Health Services

• Health History Form
  Required for any student or employee who visits Health Services seeking care.
• Student-Athlete Physical Exam in Health Services
  To be completed by student-athletes at the time of the scheduled physical exam at Health Services.
• Acknowledgment of Notice of Privacy Practices
  Required by anyone being seen/treated in Health Services. View the Notice of Privacy Practices (PDF).
• Consent for Services
  Required by anyone being seen/treated in Health Services.