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Immunization Notice
(forms)*
Immunization Requirements at the
Postsecondary Level are found in Indiana Code 20-12-71. Students
attending Indiana State University are required to comply with this code.
All full-time, new and transfer students, both undergraduate and graduate,
are required to furnish a "certificate of Immunity" for two measles, one
mumps and one rubella vaccine. A Tetanus/Diphtheria booster must be
within the last ten years.
All admitted students are sent the Health
History Form and Immunization Form to be completed and returned to the
Student Health Center as soon as possible. Registration is subject to
cancellation if the record of required immunizations are not on file.
The Health History and Immunization forms may be accessed
at the bottom of this page.
Every student must submit the
ISU Immunization form.*
Students may submit supporting materials (doctor's medical records, high
school record, childhood records, military records) but the form itself must
be submitted.
* requires the Adobe Acrobat reader (download)
IC 20-12-71-13.5 requires the
University to provide information on the risks of meningococcal disease.
It requires the student to sign the front of the immunization form
indicating they have received detailed information on the risks associated
with the meningococcal disease, the availability and effectiveness of the
vaccination. The Student Health Center does have the Meningococcal
vaccine available.
Tuberculin Skin Testing is required for both international and domestic
students. The test must be performed in the United States.
If the student is not compliant with the above requirements, a hold is
placed on their registration. These issues cannot be handled over the
phone. Students must come to the Student Health Center in person.
Parents, if your student is 18 years of age, please do not call the Student
Health Center to discuss their immunizations as HIPAA prevents us from
discussing medical information without a release of information.
The following links offer information for those who are
considering Meningitis vaccination:
http://www.
cdc.gov/nip/publications/VIS/vis-mening.pdf*
http://www.cdc.gov
* requires the Adobe Acrobat reader (download)
Exceptions for immunizations:
Exceptions may be made for meeting state requirements under
certain conditions, such as health circumstances which are exempt from immunization: pregnancy or other serious medical conditions. A written statement from a physician is necessary in all
health circumstances including the length of time for the exception.
Religious exemptions require a letter addressing documentation from the
Religious Order. Further information may be obtained by contacting the
Student Health Center at 812-237-3883.
Distance Education students are exempt from the
immunization requirements as long as they do not attend any classes or visit
the Indiana State University campus in Terre Haute, IN. If at any time
this status changes, the student is required to comply with State,
University, or Student Health Center requirements. If you are a
distance education student please complete the information on the yellow
sheet, second page at the bottom of the Immunization Record. If you do
not have one of these sheets, just send a letter (no e-mails because we need
your signature) stating you are totally a distant education student and will
not be coming to the ISU campus.
Health Record and Immunization Forms
Indiana State University Student Immunization Form
(required for registration)
Indiana State University Health
History Form
Indiana Meningitis Law
(must read)
(You will need the
Adobe Acrobat
reader
to view these forms)
The documentation must be mailed, delivered, or faxed to
the:
Director, Student Health Center
Indiana State University
567 N. 5th Street
Terre Haute, IN 47809
The confidential medical fax number is 812-237-7955.
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