Clinton Community College



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Nicole A. Powers RN BSN                     
Student Support Services Nurse

Dear Student:
Welcome to Clinton Community College! New York State Public Health Law requires that you submit proof of immunity against measles, mumps and rubella. The NYS Public Health Law also states that you will not be allowed to attend classes should you fail to submit these records. Most students have had two MMR immunizations which will satisfy the requirement. All students, regardless of age or number of credits, must complete the meningococcal meningitis form. Please note that it is NOT mandatory to get the meningitis shot, but NYS Law requires that you complete the attached form and submit it to the Health Office.  Click here-> Meningococcal Meningitis Form to complete Meningococcal Meningitis Form.


Please:


· Obtain your immunization record from your prior school or your primary care physician’s office and submit record to the Health Office.

· If you graduated or left your prior school before 1990, you will need a booster MMR immunization.

· You may receive booster MMR from your own physician or from the Clinton County Health Department for under $20.00 (565-4848).

· Positive titer test results are also acceptable forms of immunity for measles, mumps and rubella. A titer test is an order from your physician that you then take to one of the labs and have blood drawn (make sure test is for all 3 diseases).

· Titer results are usually returned within one week.

· Please make sure that the results are sent to me.

Should you have any questions, please do not hesitate to contact me by phone at 562-4129 or e-mail.

Thank you,
Nicole Powers RN BSN
Student Support Services Nurse


The Health Office is located in Room 141M (518) 562-4129, Fax (518) 562-4197 

Services Provided:

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Immunization Record 

Submit this form, or a copy from your prior school or health care practitioner's office,  to the Health Office PRIOR TO registering for classes.

Name _______________________________ Student ID # (optional) ________________

Address ________________________________________ Date of Birth _______________

New York State Public Health laws 2165 and 2167 now require post-secondary students to show immunity against Measles (Rubeola), Mumps, and Rubella (German Measles). Persons born prior to January 1, 1957 are exempt from this requirement unless the individual is in a degree program that requires this documentation (i.e. Nursing, MLT). Students taking on-line courses only are also exempt. Meningococcal Meningitis information (below) must also be completed.

REQUIRED: Measles (Rubeola) Immunity—Must have ONE of the following three:

1. TWO dates of *Measles Immunization: (1)_____________and (2)____________________

Both must be given after 1967 and the first shot must be on/after 12 months of age, the second shot must be on/after 15 months of age. (*MMR vaccine recommended for both).

2. Date of Measles Titer:____________________. Results:_________________________

3. Date of Physician’s diagnosis of disease (record must include Physician’s signature) ____________________

REQUIRED: Mumps Immunity—Must have ONE of the following three:

1. Date of one Mumps Immunization: (1)____________________. Must be on/after 12 months of age.

2. Date of Mumps Titer:____________________. Results:_________________________

3. Date of Physician’s diagnosis of disease (record must include Physician’s signature) ________________________________

REQUIRED: Rubella Immunity—Must have ONE of the following two:

1. Date of one Rubella Immunization: (1)_________________. Must be on/after 12 months of age.

2. Date of Rubella Titer:____________________. Results:_________________________

*Physician diagnosis is NOT acceptable for Rubella Immunity.

Doctor’s Name & Practice Name (PRINT):________________________________________

Doctor’s Signature:____________________________________________ Date:_________________________



Frequently Asked Questions:       

Question:
Answer:		 Where can I obtain my immunization records from?
Contact the high school that you last attended. They may have the necessary information that can be forwarded to our office. If you are an armed service veteran, you may have received the necessary immunizations through the military and can forward a copy of the records to the Records Office for review. Your family doctor may also have this information and can make a copy or fill out the purple student immunization record form.
Question:
Answer:		 What if I have a medical reason why I should not receive the MMR vaccinations?
Your doctor must certify in writing the specific reasons why you should not receive the vaccination and an approximate date on which you will be able to receive the vaccination.
Question:
Answer:		 What if I am unable to locate my immunization records?
Contact your physician, and discuss with him/her the possibility of being re-immunized or of having blood titers drawn.
Question:
Answer:		 What if I can not afford to receive the vaccination?
You should contact your local County Public Health Office. They may offer the MMR vaccination to college students for $10.00 and Meningitis vaccinations for approximately $100.
Question:
Answer:		 What if my religion prohibits me from receiving the immunization?
You may request an exemption by contacting the Records Office.
Question:
Answer:		 What are the penalties for failure to comply?
You will be prohibited from attending classes if all information is not received in the Records Office within 30 days from the start of classes. A hold will be placed on your account not allowing you to register for future classes at CCC nor will your grades or transcripts be issued until you have complied with New York State Public Health Law.
Question:
Answer:		 Could I be exempt from the MMR Requirement?
You are exempt if you are not in an allied health program, are enrolled for less than six (6) credits and were born before January 1, 1957.