Online Immunization Form
Minnesota law requires all students born after December 31, 1956, who enroll in a Minnesota college or university to be immunized against diphtheria, tetanus, measles, mumps, and rubella. This law allows for some exemptions. The law also requires the University of Minnesota to collect the information requested on this form and maintain the record for one year. All University of Minnesota students must complete this immunization form at the start of their college career. Academic Health Center students please note: You must complete a different set of immunization requirements. For more information, please review the immunization requirements web page from Boynton Health.
Date of Birth
U of M email address
Enter the year when you started your first semester at the University of Minnesota:
1989 or earlier
First semester at the University of Minnesota:
Are you a transfer student from another Minnesota college? Note: After submitting this page, if you hit the Back button to change your answers, you will need to re-select your answer in Question 4.
Yes. I am exempt from these requirements because I have met the requirements as an enrolled student in another post-secondary school in Minnesota.
Never submit passwords through Google Forms.
This form was created inside of University of Minnesota Twin Cities.
Terms of Service