Student Health & Immunization Form

Complete this form in its entirety and upload supplemental documents.

All students entering the Virginia Union University for the first time or living in University Housing must meet the immunization requirements of the University and Virginia Code § 23.1800. 
To comply with the requirements, you must provide current documentation of the following immunizations:

 MMR (Measles, Mumps, and Rubella): The student must be immunized with two doses. First MMR must be given after 1957 and not before the first birthday. The second dose must be given at least 30 days after the first. A physician’s written statement of immunity to measles and mumps due to having had the infection or proof of immunity through titers is acceptable. Students born before January 1, 1957, are exempt from the MMR requirement.

 Tetanus/diphtheria (TD booster/Tdap): Vaccination must have taken place within the past ten (10) years. A tetanus toxoid alone NOT ACCEPTABLE.

 Tuberculosis (International Students Only): All International students (those who are not Citizens or Permanent Residents of the United States) must provide documentation of TB testing prior to the start of their first semester of enrollment at USI. This testing must occur no earlier than six (6) weeks before the beginning of the semester. This test may be done with a TB blood test or a TB skin test administered in the United States by a medical professional. Send medical documentation, including your student ID number to the University Health Center (Contact information found below).

 Meningitis vaccine: Meningococcal conjugate vaccine (MCV4) two immunizations if given before 16th birthday or one immunization if given on or after 16th birthday.   
Acceptable documentation consists of one or more of the following:

 Copy of your immunization records from high school or another post-secondary institution 

 Physicians’ statement showing the month, day, and year during which the vaccinations were administered or infection was experienced.  

 Completion of the USI Student Immunization form with doctor’s signature

 Personal record maintained by your or your family showing the month, day, and year during which the vaccinations were administered. 
You may be granted an exemption from meeting state immunization requirements under certain conditions, such as a medical condition that contraindicates immunization, pregnancy or suspected pregnancy, religious objection, or participation in a current sequence of immunizations. You must provide the University with a written statement signed by your physician before an exemption for medical reasons will be considered. Further information may be obtained by contacting the DEPARTMENT at PHONE or in BUILDING AND ROOM.  
No certificate of immunization is required for admission if student or his parent submits an affidavit to the admitting official stating that the administration of immunizing agents conflicts with the student's religious tenets or practices.  Additionally, because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent's or guardians sole discretion, may elect for the parent's or guardian's child not to receive the human papillomavirus vaccine, after having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the Board.  Medical exemptions are also allowed. 
All forms MUST be submitted before check-in at VUU. Failure to comply with the Commonwealth of Virginia's Immunization Laws will result in a Student Health HOLD being placed on your registration for the upcoming semester.

Mailing Address:

Virginia Union University
The Office of Admissions
1500 N. Lombardy Street
Richmond, VA 23220.

Phone: 804.342.3570
Fax 804.342.3511
Email: admissions@vuu.edu. 

Student Contact Information
In case of emergency, please notify the following person:
Please describe below any and all allergic reactions you have experience, the severity of the reaction, and the medications you take to alleviate the symptoms.