Counseling and Wellness Center - Immunization Form
New York State Law §2165 requires college students enrolled in a degree or certificate program for at least six (6) semester hours or the equivalent per semester, or at least four (4) semester hours per quarter and who were born on or after January 1, 1957 to demonstrate proof of immunity against measles, mumps and rubella. Those students born before 1957 do not need to submit proof of immunization, but must submit proof of age. Proof of immunity consists of an official record of immunization or a letter from a doctor on his/her stationery detailing immunization history. All documents must contain a signature (and an official doctor's stamp with the name, address and telephone number) of the appropriate health official and must include the month, day and year of the immunization. Students who have not submitted complete immunization records within 30 days of the start of classes will be administratively withdrawn.
You must submit an immunization form documenting of the following:
Two (2) doses of live measles vaccine administered after 1957. The first dose must have been received on or after the first birthday and the second dose received after 15 months of age and at least thirty days after the first dose. Combined measles, mumps and rubella (MMR) is recommended for both doses.
One dose of live mumps vaccine received on or after the first birthday.
One dose of live rubella vaccine received on or after the first birthday.
In addition, Marymount Manhattan College is required to maintain a record of the following for each student:
- A signed response from the student or parent/guardian (if student is younger than 18) verifying that MMC has provided information about meningococcal meningitis and the availability of a vaccine.
- A record of meningococcal meningitis immunization within the past 10 years; OR
- An acknowledgement of meningococcal meningitis disease risks and refusal of meningococcal meningitis immunization signed by the student's parent or guardian (or the student if he/she is 18 or older).
Request for immunization records:
Marymount Manhattan College retains student immunization records for six years following graduation. Students wishing to obtain a copy of their records must submit a Request for Immunization Records form and allow 10 business days to receive their records.
Counseling & Wellness Center
Phone: (212) 774-0700