IMPORTANT
YOU CANNOT REGISTER FOR CLASSES UNTIL ALL
IMMUNIZATION REQUIREMENTS ARE SATISFIED
If you can answer “yes” to each of these checklist questions, you are ready to
submit your immunization paperwork
____ 1. I have a copy of the Student Health Services Medical Compliance
Immunization Form.
____ 2. I have completed the LEFT side of the UNF form.
____ 3a. My health care provider has provided (2) dates of MMR vaccines (both
after my first birthday) OR provided copies of my positive Measles & Rubella titer
lab results along with Meningitis and Hepatitis B dates. My health care provider
has SIGNED & STAMPED the BOTTOM of my form (office address stamp, not
signature stamp)
OR
____3b. I am attaching copies of my immunization records that lists (2) MMRs
(measles, mumps, rubella), (3) doses of Hepatitis B (or 2-dose series if indicated),
and Meningitis (menactra, menomune, menveo, meningococcal). This record has
my name & date of birth AND it has the name and physical address of my
healthcare provider, school or military location.
____ 4. I have signed the waiver of liability statement(s) located in the BOTTOM
BOX on the RIGHT side of the form because I have NOT provided dates or
DECLINE receiving Meningitis and/or Hepatitis B vaccines.
____5. All information is complete and legible.
Yeah! You are now ready to submit your paperwork to Medical Compliance:
FAX: (904) 620-2901 – black & white copies only – no colored pages.
MAIL: UNF Medical Compliance, 1 UNF Dr. Jacksonville, FL 32224
SCAN & EMAIL: s.elias@unf.edu
IN PERSON: Bldg 39A – Brooks Brown Hall, 2nd floor walkway (2100)