Proof of Immunization

We will need some forms regarding immunization requirements.

June 1 (Fall semester)

January 2 (Spring semester)

New York State Law §2165 requires college students enrolled in a degree program for at least six credits or the equivalent per semester and who were born on or after January 1, 1957 to demonstrate proof of immunity against measles, mumps and rubella. You must also prove immunity for meningitis or sign a refusal of the vaccine.  Failure to submit records could interfere with the start of classes

  • Download the Immunization Form.
  • Complete Part 1 & Part 2 yourself.
  • If you do not have records for Part 3, fax this form to your family doctor and request that he/she complete Part 3, sign it, and scan & email to or fax to 212-774-0718 or by mail.
  • If you do have records for Part 3, scan & email records AND Immunization Form with Parts 1 & 2 completed to or fax to 212-774-0718 or by mail.

Learn more about the Counseling and Wellness Center at MMC.