2024-2025 New Student Vaccination and Tuberculin Requirements


Please read the following directions carefully. Incomplete submissions will result in a registration hold.


  • All students, regardless of age or gender, must submit documentation of immunity to the following infectious diseases:
  • Measles, Mumps, and Rubella;
  • Hepatitis B;
  • Varicella;
  • Tdap (Tetanus, Diphtheria, and Pertussis); and
  • Meningococcal (Serogroups A, C, W, Y).


  • All new undergraduate and graduate students, including those in the military and those returning after an absence of one academic year or longer, must complete this form.


  • Massachusetts law requires documentation of immunity to certain infectious diseases. You can find documentation of immunization dates at schools you’ve previously attended, your doctors’ offices, or your state immunization registry. The form to request an exemption for religious or medical reasons can be found here.


  • Please read all questions carefully as some vaccine doses must be received on or after a certain date or age. For vaccinations with multiple doses, each dose must be a minimum of 28 days apart.


  • If you only know the month and year for a vaccination, please enter the first day of that month and year (i.e., 3/1/2012 for March 2012).


  • You must upload proof of vaccinations and/or proof of serologic test results, if applicable, at time of submission. Do not start this form unless you are prepared to upload all proof.

Registration Date*
Student Type*

Enter your height in inches (in.).

Enter your weight in pounds (lbs.).

Tuberculin Requirement

Have you ever had tuberculosis or had a positive tuberculosis test?*
Were you born in one of the countries or territories listed here, or have you traveled or lived for more than one month in any of these countries or territories.*

Click here for list of countries and territories.

To the best of your knowledge, have you had close contact with anyone who was sick with tuberculosis?*

Health Care Provider Documentation Required

Because of you responses, you are required to submit documentation from your health care provider.


The Tuberculin Requirement Form can be found here. This additional form is required. Have your health care provider fill out and send the form to MIT Health by the deadline that corresponds to your term start date.


We have sent an email to the address entered above with a reminder to complete and submit this form.

TB Test Required

Because of your responses, you are required to submit a Mantoux 5TU PPD skin test and result or a copy of an Interferon gamma release assay (IGRA), e.g. T-spot or Quantiferon-Gold test result. The test must have been performed within six months prior to your MIT registration date.


The Tuberculin Requirement Form can be found here. This additional form is required. Have your health care provider fill out and send the form to MIT Health by the deadline that corresponds to your term start date.


We have sent an email to the address entered above with a reminder to complete and submit this form.

Measles, Mumps, and Rubella

Select all that apply.

Combined MMR Vaccine

Note: The first dose must be after 12 months of age.

Measles Vaccine

You must provide positive serologic proof of measles, mumps and rubella immunity. Please upload all laboratory test results when submitting this form.

Mumps Vaccine

You must provide positive serologic proof of measles, mumps and rubella immunity. Please upload all laboratory test results when submitting this form.

Rubella Vaccine

You must provide positive serologic proof of measles, mumps and rubella immunity. Please upload all laboratory test results when submitting this form.

Hepatitis B

Select all that apply. Note: Heplisav is the only two (2) dose vaccine that meets the requirement.

Hepatitis B Vaccine - 3 Dose

If you have received a four (4) dose Hepatitis B vaccine, please enter the three (3) most recent doses.

Hepatitis B (Heplisav B) - 2 Dose

Note: Date must be on or after 2017 to meet the requirement.

Hepatitis B Serologic Proof

You must provide positive serologic proof of hepatitis B immunity. Please upload all laboratory test results when submitting this form.

Varicella

Select all that apply.

Varicella Vaccine

Varicella History of Disease

I attest that I have previously had varicella, also known as chicken pox, and I am providing documentation from my health care provider.

Varicella Serologic Proof

You must provide positive serologic proof of varicella immunity. Please upload all laboratory test results when submitting this form.

Tdap (Tetanus, Diphtheria, and Pertussis)

How are you able to meet the Tdap (Tetanus, Diphtheria, and Pertussis) requirement?*

Note: Your most recent dose must be on or after 9/1/2013. A Td booster does not meet this requirement.

Meningococcal (Serogroups ACWY)

How are you able to meet the meningococcal requirement?*

Select all that apply. Note: You must have received a combined meningococcal conjugate ACWY vaccine on or after your sixteenth birthday to meet the requirement. A vaccine only for meningococcal C does not qualify.

Note: The date of immunization must be on or after the student’s 16th birthday.

Waiver for Meningococcal Vaccination Requirement

I have received and reviewed the information provided on the risks of meningococcal disease and the risks and benefits of quadrivalent meningococcal conjugate vaccine. I understand that Massachusetts law requires newly enrolled full-time students at secondary schools who are living in a dormitory or congregate living arrangement licensed or approved by the secondary school, and newly enrolled full-time students at colleges and universities who are 21 years of age or younger to receive meningococcal vaccinations, unless the students provide a signed waiver of the vaccination or otherwise qualify for one of the exemptions specified in the law.

Hepatitis A

Have you received a Hepatitis A vaccination?*

Polio

Have you received a Polio vaccination?*

Human Papillomavirus (HPV)

Have you received a human papillomavirus (HPV) vaccination?*

Meningococcal Serogroup B

Have you received a meningococcal serogroup B vaccination?*

Influenza

Have you received an influenza vaccination?*

COVID-19

Have you received a COVID-19 vaccination?*

Upload Proof of Immunization

Attach an official copy of the complete immunization record and any proofs of serologic immunity testing here.

Drag and drop files here or

Certification of Accuracy

I certify that the information I am submitting is accurate to the best of my knowledge and that I have provided valid and complete documentation from my health care provider and/or state or national immunization registry.

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