Admission Health Record Packet

Complete and return the Admission Health Record Packet‌ [PDF] which includes the following:

Completed Admission Health Record Packets are due:

Return your completed packet to healthservices@saic.edu or mail to:

SAIC—Health Services
116 S. Michigan Ave., 13th floor
Chicago, Illinois 60603

Immunization Requirement Information

In accordance with the Illinois College Student Immunization Act, all students who enroll in 6 or more credit hours per semester must prove that they have been immunized against the following communicable diseases:

Measles (Rubeola): Students must provide documentation of receipt of two doses of live measles virus vaccine on or after the first birthday. The minimum time interval between each dose must have been at least 28 days. If either dose was given before 1968, proof must be provided that a live virus was administered. Students who cannot obtain records may provide laboratory (serologic) evidence of measles immunity*.

Mumps: Students must provide documentation of receipt of two doses of live mumps virus vaccine on or after the first birthday. The minimum time interval between each dose must have been at least 28 days. If either dose was given before 1968, proof must be provided that a live virus was administered. Students who cannot obtain records may provide laboratory (serologic) evidence of mumps immunity*.

Rubella (German Measles): Students must provide documentation of receipt of two doses of live rubella virus vaccine on or after the first birthday. The minimum time interval between each dose must have been at least 28 days. If either dose was given before 1968, proof must be provided that a live virus was administered. Students who cannot obtain records may provide laboratory (serologic) evidence of rubella immunity*.

Diphtheria/Tetanus/Pertussis: Students must provide dates of any combination of three or more doses of Diphtheria, Tetanus, and Pertussis containing vaccine. One dose must be the Tdap vaccine. The last dose of vaccine (DTP, DtaP, DT, Td, or Tdap) must have been received within the last 10 years. The minimum time interval between the first and second dose must have been at least 28 days, with the third dose having been received at least six months after the second or last dose of the basic series.

Meningococcal Conjugate Vaccine: All new admissions under the age of 22 must show proof of having at least one dose of meningococcal conjugate (Menactra®, Menveo®, and MenHibrix®) vaccine on or after 16 years of age.

*A serology report is a blood test you can have done by your healthcare provider to test for positive antibodies which prove immunity. Lab results must be attached.

Exemptions that will be accepted:

  1. Medical Exemption: Students who have a medical reason that contraindicates vaccination should ask their healthcare provider to complete the Medical Immunization Exemption Form [PDF].
  2. Religious Exemption: Students who have a religious objection to immunization should complete the Religious Immunization Exemption Form [PDF].
  3. Pregnancy or Suspected Pregnancy: Students who are pregnant or suspected to be pregnant should ask their healthcare provider to complete the Medical Immunization Exemption Form.

Anyone with a vaccine exemption may be excluded from the College in the event of a disease outbreak in accordance with public health law.

Please note: if you were born on or before January 1, 1957, you are exempt from the measles, mumps and rubella requirements, as exposure to disease and natural immunity is assumed. You will however, need to show proof of immunity to diphtheria, tetanus, and pertussis.

Proof of Immunity

Proof of immunization, a certificate of medical exemption to immunization, or a statement of religious objection to immunization must be on file with SAIC Health Services prior to registering for class. Students who do not have one of these three documents on file with Health Services by the beginning of preregistration will have a registration hold placed on their academic record and will not be permitted to register for the following semester.

Students can submit proof of current immune status to the above diseases by attaching relevant records from a high school, prior college, military, government, clinic or hospital or by having the SAIC Certificate of Immunity below completed and signed by a health care provider. Documents must be in English. Please send copies and retain original documents for your own records.

IMPORTANT: You will be notified at your SAIC email account if we receive incomplete records. This email address will be used for future communications from Health Services as well.

Recommended (not required) vaccines for college students:

CDC: Diseases & Conditions

ACHA: Immunization Recommendations for College Students [PDF]