Proof of Meningitis Submission

The vaccination must have been administered within five years of enrollment, and the latest possible date to receive the vaccine is 10 days prior to the first day of the semester. Please provide your valid email address and current phone number so that we may reach you if needed.

All fields marked with an asterisk (*) are required.

required text field

Full Legal Name:*

text field

Campus ID #:

Preferred, but if unknown you may leave this field blank.

required text field

Last 4 digits of SSN:*

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Date of Birth:*

required email address field

Email Address:*

Please provide your valid email address.

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Current Phone:*

Please provide your current phone number.

required date field

Today's Date*

required file attachment field

Upload Current Proof of Meningitis Vaccination.*

**Reminder: Vaccination is not valid if over 5 years.

(50 MB max)

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I Certify*

That this information is complete and correct to the best of my knowledge. I authorize the university to verify the information I have provided. I understand that submission of false information is grounds for withdrawal, cancellation of enrollment, and/or disciplinary action.

Link (required)