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Updated: April 2016

Completing the Immunization and Medical History Forms

Instructions for completion of required forms:

  1. Immunization History Form (required) download
    • Print the form and complete the demographic (top) portion of the form.
    • Ask your physician or nurse to complete and sign the Immunization History form (physicianís office address and phone number must be included on the form). In lieu of completing the form you may attach a copy of school immunization records, physician records or military records to the form.
    • Submit the form to McKinley Health Center by the specified deadline:
          - July 1st for Fall semester
          - December 1st for Spring semester
          - April 1st for Summer semester
    • If you fail to submit your forms, you will be allowed to register for classes for your first semester. However, you will not be able to drop classes in that semester and you will not be allowed to register for classes for subsequent semesters until you are in compliance.
    • International Students: Bring a copy of your forms with you to campus. You must provide a certified English translation if immunization records are not in English. If you do not have adequate documentation of your vaccinations, you may repeat the shots before coming to the United States or the shots can be provided at the Health Center for a fee.
  2. Although you must complete the Immunization History form, the Medical History form is not required. When you schedule your first appointment at the Health Center, you'll be asked to complete the form.
  3. International Students ONLY: TB Screening Form (required)
    • Print and complete the TB Screening Form.
    • Bring this completed form and a copy of your Immunization History Form with you to campus. Do not fax your TB Screening Form.
  4. Under 18 years of age?
  5. For additional information, contact the Immunization and Travel Clinic at (217) 333-2702

Optional Disclosure of Private Mental Health Information*

  • * In compliance with the Student Optional Disclosure of Private Mental Health Act, the university has established procedures for students to have the opportunity to authorize, in writing, the disclosure of certain private mental health information to a designated person. Access to this information will be provided only to qualified examiners. To make such a disclose please click on the above link.


Why do I need to submit these forms?

The Illinois College Immunization Code requires that college students be immunized against tetanus, diphtheria, measles, mumps, and rubella. Proof of immunity must be signed/certified by a health care provider or public health official. International students are required to undergo tuberculosis screening when they arrive on campus.

What are the vaccination requirements and are there fees?

Illinois requires all college students to be immunized against certain vaccine-preventable diseases. These include:

 Measles - Two vaccinations required, on or after the first birthday. Must be live vaccine, which was available after 1967
 Mumps - One vaccine
 Rubella - One vaccine
 Tetanus/diphtheria US Citizens and Permanent Residents: booster within 10 years of the first day of the start of classes. International Students: documentation of at least three tetanus and diphtheria vaccinations, the third given within 10 years of the first day of the start of classes.

You can receive any or all of the required immunizations at McKinley for a charge. See charges for vaccinations.

What are the tuberculosis screening requirements?

Tuberculosis Screening Requirement: Tuberculosis screening must be conducted at McKinley Health Center and is required for all international students. If youíve had tuberculosis, bring copies of your medical records with you to campus. Failure to comply with tuberculosis screening requirements will prevent you from adding/dropping classes during the current semester and registering for classes during subsequent semesters.

How do I complete TB Screening requirements and are there fees?

All new international students are screened for tuberculosis. Screening consists of completion of a paper questionnaire and a Quantiferon TB Gold blood test for student who have lived in countries outside of the United States, Canada, Australia, New Zealand, or Western Europe. There is a $30 charge for the blood test. Students who have a positive blood test will be asked to return for chest X-ray to screen for pulmonary tuberculosis. Students who have a prior history of tuberculosis or who are receiving treatment for tuberculosis should bring copies of all treatment records, including medical notes and laboratory reports.

How can I submit my forms and records?

You can fax, mail or drop-off your documents. You can fax to 1-217-244-1278. Documents can be received by fax 24 hours a day. You can mail documents to: McKinley Health Center, Attn:
    McKinley MIS
    1109 S. Lincoln Ave.
    Urbana, IL 61801
We are not able to accept documents by email. Please include your University Identification Number (UIN) on each document.

Is a physician signature required on the Immunization History Form?

A doctors signature is not required if you send us official immunization records. If you are sending unofficial records, a health care professionalís signature is required.

Is a physical exam required?

No, a physical exam is not required for admission. The medical background provided by the student on the Medical History form is sufficient.

I have to submit my forms late, what will happen?

There is not an immediate penalty for submitting the forms after the deadline; however, it is very important to submit them as soon as possible. Students who do not submit by the deadline will receive email notificationthat failure to comply by a designated date will not be able to add or drop classes during the current semester and register for classes during subsequent semesters.

Will I be notified that my documents were received?

Yes. You will receive an email notification to confirm receipt of your documents/compliance with State immunization requirements. If your records are incomplete, you will receive an email informing you of any missing immunization requirements.

Are there any exemptions to the requirements?

  • Medical exemption - A written, signed and dated statement from a physician stating the specific contraindicated vaccine(s), the reason why and duration of the medical exemption is required.
  • Pregnancy or suspected pregnancy - A signed and dated statement from a physician indicating that you are pregnant (include expected date of delivery) is required. After delivery, you must then comply with State Immunization requirements as directed by your physician.
  • Religious exemption - Contact the Office of the Dean of Students at (217) 333-0050.

What health care services can I receive as a student at the University of Illinois?

Learn more about services offered at McKinley Health Center


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