(Be sure to keep a copy of this form for your records.)
The State of New Jersey enacted a law in 1995 requiring each full-time student to provide the college with a valid record of immunization verifying two (2) live doses of the MMR (Mumps, Measles and Rubella) vaccine or verification of immunity and three (3) doses of Hepatitis B Vaccine.
If you plan to enroll full-time, submit either your high school health record indicating two (2) lives doses or this form signed by a physician to the Admissions Office prior to the first day of class.
____ I am exempt for religious reasons. Documentation from my religious official is attached.
____ I am exempt because I was born before 1957.