UST be completed by a healthcare provider. Forms signed by students or parent/guardian cannot be accepted. All forms mailed must be sent to the address listed below. Do not submit documentation to any other department. Forms may be faxed to Enrollment Services at 973-877-3446. Your student ID or social security number MUST be on the form/s. New student enrolling in a program leading to an academic degree, who registers for 12 or more credits per semester, shall be vaccinated and records submitte.
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How to fill out the Essex County College Immunization Form online
Filling out the Essex County College Immunization Form online is a straightforward process. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently.
Follow the steps to complete the form correctly.
- Click the ‘Get Form’ button to access the immunization form and open it for editing.
- In Part 1, enter the student’s name (last, first, and middle initial), address, phone number, date of birth, and their Essex County College ID number. Ensure that all information is printed clearly.
- Move to Part 2, which must be completed by a healthcare provider. This section requires the vaccination history, including dates for two doses of measles, one dose of mumps, rubella, or two doses of MMR, and three doses of Hepatitis B.
- Once the healthcare provider has filled out Part 2, they must provide their signature and official stamp in Part 3, confirming the immunizations given. The provider's name, signature, office number, and address are necessary.
- Review the completed form for accuracy and completeness. Missing or unclear information can delay processing.
- Submit the form by either mailing it to the designated address or faxing it to Enrollment Services. Make sure to include the student ID or social security number on the form.
- Users may download or print the filled form for their records after submission.
Complete your Essex County College Immunization Form online today to ensure timely processing of your enrollment!
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