****All new/first year students are required to complete Pre-Matriculation Immunizations***

Rollins Student Health Portal 

Pre-Participation Intercollegiate Sports Physical Forms

New Students Pre-Matriculation/Immunization Form

REQUIRED IMMUNIZATION

College Policy requires the following immunizations for all students, documented by your health care provider.

Health Care Provider must complete this section in English.

Provide month, day and year of vaccine or dated copy of titers and reports. The following are required:

1. Two doses of measles, mumps, rubella combined in an MMR (2 doses after 1^st birthday) OR   Laboratory reports of titers for immunity of measles (rubeolla), mumps and rubella.

AND 

2. Three doses of Hepatitis B vaccination at intervals of 1 month apart, and the third at six months from the first dose. The hepatitis vaccination series is not restarted. So if a dose is missed, the series can still be completed as a series of three; OR Laboratory reports with titers for antibodies to Hepatitis B.

AND

3. One or Two doses Meningitis vaccination all students – revaccinate every five years if increased risk

AND

4. A booster dose of Tetanus, Diphtheria, Pertussis (Tdap/Adacel) within 10 years of this date

5. Tuberculosis Screening: Required for International Students & most Health Programs (see form)

6. Exemptions: Exemptions to the immunization policy (based on Florida State policy and / or College policy) may be granted for valid medical or religious reasons.

Permanent Immunization Exemption Form

STRONGLY RECOMMENDED for your Health! (but NOT required)

• Varicella #1 (Chickenpox)

• Varicella #2 (Chickenpox) or History of Chickenpox Disease

• Hepatitis A #1

• Hepatitis A #2

• HPV (Gardasil) #1, #2, #3

• Polio (last dose date)