Immunization Record Form

The Immunization Record form is completed and signed by the student ONLY. If the student is less than 18 years then the parent/guardian signs the form.

Download Fillable CUNY Immunization Record Form & Meningitis Fact Sheet 04182020.pdf — 809 KB

Email StudHealthSvcCtr@york.cuny.edu if you need assistance. Follow us on twitter @york_health for updated information.