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Immunization Form

All students, full time and part time, graduate and undergraduate, must submit an immunization record.  Click the link on the right side of this page to download the form.
PLEASE use only these forms!

Requirements are based on The Connecticut Department of Public Health. 

 As of 12/5/11, the following are required:

It must be completed with your registration/acceptance to the University. Documentation must be clearly legible and have your school ID number or Social Security number CLEARLY WRITTEN.

This form must be signed or stamped by your physician or you may attach a copy of records from another school or physician office--you must still fill out the demographic portion of our form and attach your records.  Demographic information is required file the forms.

Please fax the form to 860.768.5140, or mail to:

    Student Health Services
    University of Hartford
    200 Bloomfield Avenue
    West Hartford, CT 06117


Before beginning school, all students must submit their immunization records. This includes undergrads, graduate, part-time and full-time students. 

Requirements vary depending on your status.  Please see below:

A physical is not required!

The state of Connecticut mandates that all students supply the following information:

  1. All students must show proof of two MMR’s (measles, mumps, rubella).
    You are exempt if you were born before 12/31/56.
    Disease history is not acceptable for this requirement.
    Please contact Health Services if you are age exempt.
  2. All incoming freshman and transfer students beginning 1/1/2010 must show proof of two varicella (chicken pox) vaccines.
    Documentation by your physician of the disease is acceptable.
  3. All students living in any campus housing must show proof of having had the meningitis or menactra vaccine.

    ***NOTE:  The CDC recommendation:
    If you have had the older meningitis vaccine (MPSV4), prior to age 16 or over 3-5 years prior, you will need a booster vaccine to cover you through your college years.
    If you had the newer menactra vaccine (MCV4) after the age of 16, you do not need a booster.
    If you had your first dose of menactra between the ages of 11-15 , you need a booster shot prior to coming to school.  Please consult with your doctor.
    Please see the CT immunization requirement for meningitis vaccine for all incoming students 2014/2015.  Vaccine must also not have been administered over 5 years prior to start of school 8/25/14 without booster. 
    http://www.ct.gov/dph/lib/dph/infectious_diseases/immunization/cvp/update_new_college_meningococcal_requirement.pdf 
  4. The Meningitis vaccination is strongly recommended for all off campus students as well.

    Any student who is not compliant will have a hold placed on all future registration of classes until they submit the documentation. Please DO NOT delay!

Health Form

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Undergrads, please use this form for immunization and health history.  Get Form