Get Purdue University Immunization History Form 2022-2025

Completing the Purdue University Immunization History Form online is an essential step for students to ensure compliance with health requirements. This guide provides step-by-step instructions to help you navigate the form with ease.

Follow the steps to complete the form accurately

1. Press the 'Get Form' button to access the immunization history form and open it in your preferred document editor.
2. Begin filling out your personal information. Enter your last name, first name, Purdue ID number, and date of birth in the designated fields, using the MM/DD/YY format.
3. In section A, provide your tetanus/diphtheria immunization date. Indicate either the Td or Tdap vaccine received, including the date.
4. In section B, fill in the MMR (measles, mumps, rubella) details. You can enter two doses or the individual doses for each component, ensuring the first dose is after your first birthday.
5. For section C, if you are 23 years old or younger, enter the date of the meningococcal quadrivalent vaccination given on or after your 16th birthday.
6. In section D, also for students 23 years or younger, provide details for the meningococcal B vaccine, including the doses and their respective dates.
7. Ensure a licensed provider, such as an MD, DO, NP, or RN, signs the form. Include the provider's signature and the date of signing.
8. Once you have completed all sections, review the information for accuracy. Save your changes or download the form. You can also print or share it as needed.

Complete your immunization history form online to fulfill Purdue University's health requirements.