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Bloomfield College Immunization Form

Nursing Clinical Clearance Form

Medical Records Release Form

New Jersey State Statute Immunization Requirements - Measles, Mumps, Rubella

All new or continuing undergraduate and enrolled in a program of study leading to an academic degree at any 4-year public or independent institution of higher education in NJ are required to provide evidence of immunization as a prerequisite to enrollment as follows:

  • Measles: Evidence of two doses of a live measles-containing vaccine, or any vaccine combination containing live measles vaccine that was administered after 1968 - first dose administered on or after the student's first birthday and second dose administered no less than one month after the first dose, or documented laboratory evidence of measles immunity. A student vaccinated with a killed measles containing vaccine, or an unknown vaccine prior to 1969, must be revaccinated or produce laboratory proof of measles immunity.
  • Mumps: Two doses of live mumps virus vaccine, or any vaccine combination containing live mumps virus vaccine on or after the student's first birthday, or documented laboratory evidence of mumps immunity.
  • Rubella: Two doses of live rubella virus vaccine, or any vaccine combination containing live rubella virus vaccine on or after the student's first birthday, or documented laboratory evidence of rubella immunity.

Documented proof of immunity must be submitted to the Wellness Center. Failure to submit the required documentation will result in a hold being placed on your record. This hold will prevent you from registering for classes. You can send or fax original documentation signed by a licensed health care provider, a copy of a signed and authorized school record, or the completed and signed Immunization Information form to:

Bloomfield College Health Services
26 Austin Place
Bloomfield, NJ 07053


Make sure to return the required proof stated for the chosen exemption to Health Services Office (not the Admissions Office)

  • Age exemption:
    • Born prior to January 1, 1957
    • Attach copy of birth Certificate
  • Medical exemption*
    • Must be reviewed annually to determine continuation of exemption. Physician’s statement explaining why you cannot be immunized at this time required. Statement must include diagnosis. If pregnant, indicate your due date.
  • Immune status
    • (Measles, Mumps antibody & Rubella titers)
    • Laboratory blood results showing that you are immune required.

A good place to start looking for your documentation is with your private physician or the last school or college you attended.

If you are unable to locate your immunization records or they are incomplete, the next option is to provide proof of immunity by serological report, a blood test that your doctor must order.

You may opt to take the vaccinations again. Remember they must be given at least 30 days apart. You may opt to take the vaccinations again with your personal healthcare provider or Health Department.


Meningococcal disease is a potentially fatal bacterial infection commonly referred to as meningitis. On October 20, 1999, the CDC's Advisory Committee on Immunization Practices (ACIP) voted to recommend that college students be educated about meningitis and the benefits of vaccination. The panel based its recommendation on recent studies showing that college students, particularly freshman living in residence halls, have a sixfold increased risk for meningitis. The recommendation further states that information about the disease and vaccination is appropriate for other undergraduate students who also wish to reduce their risk for the disease. The State of New Jersey passed legislation requiring that all full and part-time incoming college freshmen, and transfer students must be provided with this information and documentation of the student's decision whether or not to receive vaccination must be recorded by each college.

Meningitis is rare. However, when it strikes, its flu-like symptoms make diagnosis difficult. If not treated early, it can lead to swelling of the fluid surrounding the brain and spinal column as well as severe and permanent disabilities and even death. Cases of meningitis among teens and young adults 15 to 24 years of age have more than doubled since 1991. The disease strikes about 3,000 Americans each year and claims about 300 lives. Between 100 and 125 meningitis cases occur on college campuses and as many as 15 students will die from the disease.

Currently two different types of meningitis vaccines are available. The first vaccine, Menactra® and Menveo®, protects against four strains of meningococcal bacteria known as A,C,Y,W135 ®), which account for nearly two thirds of meningitis cases among college students. Bloomfield College requires this vaccine for all students under the age of 19 and all students (regardless of age) who live in on-campus housing. A second vaccine, Bexsero® or Trumenba® protects against Meningitis type B. Although not mandatory, the CDC's Advisory Committee on Immunization Practices (ACIP) recommends, that given the seriousness of meningococcal disease and the availability of a licensed vaccine, individuals are encouraged to consult with their healthcare provider regarding administration of this vaccine.

  • Clinical Features: Fever, headache and stiff neck in meningitis cases, and sepsis and rash in meningococcemia.
  • Etiologic Agent: Multiple serogroups of Neisseria meningitidis.
  • Incidence: 0.5-5/100,000 for endemic disease, worldwide in distribution. During 1996-1997, 213,658 cases with 21,830 deaths were reported in West African countries. Up to 2% in epidemics in Africa.
  • Sequelae: 10%-15% of cases are fatal. Of patients who recover 10%-15% have permanent hearing loss, mental retardation, loss of limbs, or other serious sequelae.
  • Transmission: Generally occurs through direct contact with respiratory secretions from a nasopharyngeal carrier.
  • Risk Groups: Risk groups include general population, infants and young children (for endemic disease), refugees, household contacts of case patients, military recruits, college freshmen (who live in dormitories), microbiologists who work with isolates of N. meningitidis, and people exposed to active and passive tobacco smoke.

For more information about meningitis and the vaccine, contact your local health department or consult your private health care provider.


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