Important Immunization Information
INSTRUCTIONS: This form must be completed in order to register for classes at The University of Tennessee at Chattanooga. The health care provider’s signature or stamp must be provided in the appropriate space or a copy of medical records documenting contraindication or immunity must be attached.
RETURN TO: The University of Tennessee at Chattanooga, Department 1951, 615 McCallie Avenue, Chattanooga, TN 37403 or FAX to (423) 425-5357.
- MMR: All students born on or after January 1, 1957 must provide proof of immunization with two doses of MMR vaccine at least 28 days apart or serology showing immunity to MMR.
- Varicella or Chickenpox: All students born on or after January 1, 1980 must provide proof of immunization with two doses of Varicella vaccine at least 28 days apart, serology showing immunity to Varicella or documentation from a medical facility verifying a previous diagnosis with the illness.
- Hepatitis B: All students must provide proof of immunization with three doses of Hepatitis B vaccine or documentation of serology showing immunity to Hepatitis B virus. The State of Tennessee does allow a waiver of the requirement by completing the waiver statement on the reverse side of this form.
- Meningitis: New incoming students, who are less than 21 years of age, who will be residing in on campus housing, must have documentation of a dose of conjugate vaccine at greater than or equal to 16 years of age. Any student not residing on campus who has not received a dose of conjugate vaccine within the past 5 years may choose to be vaccinated to reduce the risk of meningococcal disease.
The staff of Student Health Services (SHS) seeks to give every student, faculty and staff member optimum healthcare. Services include visits for acute and chronic illnesses, physical exams, screenings, immunizations, lab services, TB skin testing and allergy shots.
As of Aug. 1, 2013, SHS will be located in Room 205, Maclellan Gymnasium, in the center of campus. The entrance to SHS will be off of Lansing Court, directly across from the University Center.
Student Health Services is staffed by nurse practitioners and provides primary health services to students, faculty and staff. Students will not be charged for office visits, and will incur minimal charges for services such as laboratory tests and immunizations. Office appointments are strongly encouraged.
We also encourage all students to carry personal health insurance, either through their family health plan or by enrolling in the UT Health Insurance Program, an affordable health care coverage plan. Please call (423)425-2266 for further information on Student Health Services, or to learn more about the UT Health Insurance program.