Pre-Registration Immunization Requirement Form

New students must provide a completed Medical Requirement Form before they register. Page 1 asks for validation of rubella and rubeola immunizations. A copy of the official immunization record or blood titers must accompany the Medical Requirement Form or the required information is filled in by a health care provider who also signs and dates this form. New students must also complete the tuberculosis screening questionnaire (page 2). A student will not be allowed to register until UM's Curry Health Center receives this form with the correct information and documentation.

You may download the form from the Curry Health Center's web site at the Link below.

Forms

Curry Health Center Forms