This form consists of four pages and should be read carefully. All students must complete the demographic information at the top of the form and sign in Section D. Students under the age of 18 must also have a parent/guardian sign in Section D. Students born after 1956 must have Sections A and B completed by a physician if official immunization documents are not attached to the form. Students (or their parent/guardian if the student is under the age of 18) must sign in Section B if they do not have documentation of vaccination against Meningococcal Meningitis and/or Hepatitis B and elect to waive either or both of those vaccines.
Student Health Clinic, Room SR106
Florida Atlantic University
If you have any questions, call 561-297-0049.