Immunization Forms

New York State Public Health Law 2165 now requires post-secondary students to show protection against Measles, Mumps, and Rubella (MMR).
Persons born before January 1, 1957 must provide proof of rubella immunization. Persons born on or after January 1, 1957 are required to present proff of immunity against Measles, Mumps, and Rubella (MMR).

Click the link(s) below to retrieve the necessary form(s).

Student Immunization Record Form

Meningococcal Meningitis Vaccination Response Form


Please fax, mail or bring in the forms:

Office of Health Services
222-05 56th Avenue, Room MC-02
Phone: (718) 631-6375
Fax: (718) 631-6330


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