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IMMUNIZATION FORM Name PLEASE PRINT (Last) ID: (First) Z Birthday / MONTH Gender: M F Health Services DeKalb, Illinois 60115-2828 815-753-1311 www.niu.edu/healthservices / DAY Term Entering NIU: YEAR.

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How to fill out the Niu Immunization online

Completing the Niu Immunization form is a crucial step for students enrolling at Northern Illinois University. This guide provides clear, step-by-step instructions to help users effortlessly complete the online form.

Follow the steps to successfully fill out the Niu Immunization form.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by providing your personal information. Fill in your last name, first name, and birthday in the designated fields. Ensure that all details are clearly printed.
  3. Next, indicate your gender and the term you are entering NIU by selecting the appropriate options.
  4. In the required immunization section, provide the month, day, and year for each dose administered. Fill in the fields for DPT, Tdap, and MMR, ensuring you accurately document every vaccination.
  5. If applicable, provide the disease date or titer date for rubella and mumps, attaching a copy of the titer where required. Remember that a diagnosis of disease is not acceptable.
  6. Complete the fields for the health provider's information, including their signature, address, and phone number to verify that immunizations were given.
  7. Move to the recommended immunizations section and check any additional immunizations as required by your specific program. Document the relevant dates.
  8. If you are under 18 years of age, ensure that a parent or guardian signs the consent statement for treatment and provides their printed name and date.
  9. Finally, review all entered information for accuracy and completeness. You can then save changes, download, print, or share the form as needed.

Complete your immunization documentation online today for a smooth enrollment process.

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About COVID-19 Vaccination Requirements NIU strongly encourages every Huskie to be vaccinated and up to date on their vaccines. Many clinical placements, internships and practicums are requiring participating students to be fully vaccinated.

Based on Illinois State Law and University Policy, all students taking course work that has been coded as 'On Campus' by the Academic Deparment are required to provide proof of immunity for Tetanus, Diphtheria, Pertussis, Measles, Mumps, Rubella and Meningitis.

Code 694) requires all domestic and international students have the following vaccines: Three (3) vaccines that contain tetanus/diphtheria/pertussis, one of which must be Tdap vaccine. The last dose of vaccine must be within 10 years.

Document Submission: 60115-2828 Or • Bring into Health Services Building, Immunization Compliance office, 2nd floor. Your records are not complete until they have been reviewed and verified by the Immunization Compliance office. All records must be in English and legible.

If you're new to NIU, you may be required to take placement exams, which provide information that helps determine which NIU courses you should take. You should take any required exams as early as possible.

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