Connecticut State University Student Health Services Form
Fall Enrollment Deadline: August 1
Spring Enrollment Deadline: January 1
- Connecticut State Statute, Sec. 10a-155, requires that each full-time or matriculating student MUST provide proof of adequate immunization or screening against measles, mumps, rubella, varicella and tuberculosis before enrolling in the university.
- Be sure to complete the entire form, including the TB Risk Assessment Questionnaire (Section 6)
- Incomplete forms will not be processed.
- Additional requirement for students living in on-campus housing:
- Meningitis vaccination – all students living in on-campus housing must provide proof of receiving at least one dose of meningococcal conjugate vaccine (Menactra or Menveo) not more than 5 years before enrollment.
- Additional recommended but not mandatory immunizations:
- Hepatitis B – to prevent a serious disease caused by a virus that attacks the liver causing lifelong infection, cirrhosis, liver failure and death.
- Meningitis Serogroup B – Since 2015, ACIP has recommended routine use of MenB vaccines (Trumenba, Bexsero) in certain groups of individuals at increased risk for serogroup B meningococcal disease, including during outbreaks.
- Immunization Exceptions:
- MMR is not required for those born before January 1st, 1957
- Varicella is not required for those born before January 1st, 1980
- Immunization record is not required with a valid medical or religious exemption. See Request for Exception from Required Immunizations form.
- Distance Learners are exempt from the immunization requirements if all courses are on-line.
- Athletic forms
- Club sports pre-participation evaluation.
- Medical Parking Permit Form
- Release of Information/Records Form
PLEASE NOTE: A student’s CSU Health Form, immunization records and all other medical records are maintained on file at the Student Health Service office for a period of 7 years after the student leaves the University. They are CONFIDENTIAL health records and will NOT be released without written consent of the student.