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 6856, 615 McCallie Avenue, Chattanooga, TN 37403 or FAX to (423) 425-2305.
If you have questions, please email Student Health Services at firstname.lastname@example.org. You may call (423) 425-2337, however emails are returned more rapidly. Please include your name, UTC ID, email address, telephone number and term of registration (fall 2014, etc.), with a brief message.
- 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.
Copies of Immunizations for Enrolled Students
UTC keeps copies of student immunizations for two years beyond freshmen/transfer enrollment, after this time the documents are destroyed. Please keep a copy of these vital records once you obtain them. If you submitted your immunization record to UTC within the past two years, and need a copy, please send an email to email@example.com. Please include your name, UTC ID, email address, telephone number and term of freshmen/transfer enrollment (fall 2012, etc.), with a brief message. If you would like this information faxed to another institution, please include the name and fax number of the institution, along with name of recipient.