Forms

• Immunization Form
• Consent to Release Immunization Records Form
  
• Request for Religious Exemption to Immunization Form

Submitting Forms & Retrieving Records

The following forms may be printed, completed, and submitted to Health Services, Room 307, North Building. For more information about immunization requirements and documentation, please visit our Immunization Requirements page.

• Immunization Form
  

Do you need a copy of your immunization records for your personal records or would you like them to be sent to another institution? Health Services can release your immunization records in one of the following ways:

1. You can pick up your records in person at Health Services, Room 307, North Building (a valid photo ID is required)
2. Or you can fax, email or mail the Consent to Release Immunization Form. If you are e-mailing the form, it must be scanned in a PDF format and you must attach a valid and legible photocopy of your ID. No mobile snapshots of IDs will be accepted.

• Consent to Release Immunization Records Form
  

Any student whoes religious belief prohibits vaccination must complete the CUNY Religious Exemption Form.  Exempted students will not be permitted on campus during a communicable disease outbreak.

• Request for Religious Exemption to Immunization Form
  

* When downloading forms, (Adobe Acrobat Reader) is required.