Health Clearance Form

Please fill out the form below. If you wish to fill out a printable form, please click here to download the PDF form.

  • Current Personal Information
  • Immunization Information
  • Complete
Contact Information
Year of Entry
Student Type

New Jersey State Law

All undergraduate students enrolled in a program of study leading to an academic degree and born after 1956 must provide the college with proof of having received two injections of Measles, Mumps and Rubella vaccine, either separately or as a combined MMR vaccination, or laboratory proof of immunity to each of these infections.

Beginning with the 2008-09 academic year, all new students must be vaccinated for Hepatitis B (a series of 3 shots) within nine months of attendance as a condition or continued attendance at Bloomfield College. Three Hepatitis B vaccinations complete the series.

As a service to Bloomfield College students, the Bloomfield Board of Health is pleased to offer vaccinations, needed for college, at a reduced cost. Arrangements can be made with the school nurse. More information can be found here.

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