BMCC, CUNY Immunization Record for Students
This form is used by students registering for 6 credits or more to provide proof of immunization. It includes student information, immunization history, and meningococcal meningitis vaccine response. The document must be legible and include all required documentation.
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How do I fill this out?
To fill out this form, you'll need to provide your personal information, immunization history, and sign the meningococcal vaccine response section. Ensure all fields are completed accurately. Finally, submit the form to the Health Services office.
How to fill out the BMCC, CUNY Immunization Record for Students?
1
Provide your personal information including name, date of birth, and contact details.
2
Have your health care provider fill out and document your immunization history.
3
Complete the meningococcal meningitis vaccine response section.
4
Sign and date the form.
5
Submit the completed form to the Health Services office at BMCC.
Who needs the BMCC, CUNY Immunization Record for Students?
1
Incoming students enrolling for at least 6 credits need this form to provide proof of immunization.
2
Students born after January 1, 1957 are required to submit this form to comply with state laws.
3
International students must ensure their immunization records are translated and submitted.
4
Students under 18 need to have this form signed by a parent or guardian.
5
Health services staff will need this form to verify student immunizations.
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1
Upload the BMCC Immunization Record to PrintFriendly.
2
Use the PDF editor to fill in personal information and immunization history.
3
Check for accuracy and completeness of all fields.
4
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5
Download the final version for submission.
What are the instructions for submitting this form?
Submit the completed BMCC Immunization Record to the Health Services office in room N380. You can either mail it to BMCC Health Services: 199 Chambers Street, Room N380, New York, NY 10007; fax it to 212-220-2367; or email it to Healthservices@bmcc.cuny.edu. Ensure all sections are filled out accurately and include necessary documentation such as immunization dates and health care provider’s signature/stamp. Verify your submission has been received to avoid any registration issues.
What are the important dates for this form in 2024 and 2025?
Ensure submission of the BMCC Immunization Record before enrollment dates for 2024 and 2025 semesters: Spring 2024 - January 15, Fall 2024 - August 20, Spring 2025 - January 15, Fall 2025 - August 20.
What is the purpose of this form?
The BMCC Immunization Record form is essential for students enrolling for 6 or more credits at any CUNY campus. Its purpose is to ensure that students comply with New York State Public Health Law, requiring proof of immunity to measles, mumps, and rubella. Additionally, it includes a section for meningococcal meningitis vaccination response, which is crucial for enrolled students' health safety.
Tell me about this form and its components and fields line-by-line.
- 1. Student Information: Includes fields for personal details like name, date of birth, and contact information.
- 2. Immunization History: Requires a health care provider to document immunization dates and validate with a signature.
- 3. Meningococcal Meningitis Response: Allows the student to acknowledge receipt of meningococcal disease information and indicate vaccination status.
- 4. Health Care Provider Information: Includes fields for the provider’s name, address, license number, and official stamp.
- 5. Office Use Only: Section for Health Services staff to process and validate the form.
What happens if I fail to submit this form?
Failure to submit the immunization form can result in registration holds and inability to attend classes.
- Registration Holds: You might not be able to register for classes without submitting the form.
- Health Risk: Increased risk of disease spread on campus without verified immunization.
- Non-compliance: Failure to comply with New York State Public Health Law mandates can lead to administrative actions.
How do I know when to use this form?
- 1. New Enrollment: Required for all new students registering for 6 or more credits.
- 2. International Students: Students with foreign immunization records need to submit translated versions.
- 3. Returning Students: Returning students who previously did not submit immunization records need to provide them.
- 4. Health Services Verification: Necessary for Health Services to verify and maintain student immunization records.
- 5. Legal Compliance: Ensures compliance with state health laws regarding immunizations.
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