James Madison University Immunization and TB Screening Form

To submit the JMU Immunization Form, first ensure the form is completed and signed by a healthcare professional. Next, log in to your MyJMUChart account and upload the completed form along with a copy of your health insurance card (both front and back) in PDF format. If you have any questions, you can contact the University Health Center at healthcenter@jmu.edu or fax your documents to (540) 568-7803. Submissions can also be mailed to: James Madison University Health Center, MSC 7901, Harrisonburg, VA 22807. Always check for the latest submission guidelines on the university’s website.

For the year 2024, the form submission due dates are July 8 for Fall semester start and December 13 for Spring semester start. For the year 2025, the due dates remain the same. Graduate students must submit their forms by the third Friday of their first semester.

The James Madison University Immunization and TB Screening Form serves an essential purpose in ensuring the health and safety of the university community. It collects vital immunization records and TB screening results for all incoming students, which helps prevent the spread of infectious diseases on campus. Compliance with this form is mandated by the Commonwealth of Virginia law, emphasizing the importance of maintaining up-to-date health records in an academic setting. By requiring this form, JMU is able to monitor and manage the health of its student population effectively. The accurate and timely submission of immunization records helps the university health center identify and address any potential health risks promptly. This proactive approach contributes to a healthier campus environment and ensures that all students have met the necessary health prerequisites for enrollment. Furthermore, the form serves as a critical tool for individual students to track their immunization status and receive necessary vaccinations. The required and recommended immunizations outlined in the form protect students from various diseases, thereby promoting public health within the university community. Meeting the submission deadlines and adhering to the immunization requirements reaffirm JMU's commitment to the well-being of its students.

• 1. Name (print): Student's full name, printed clearly.
• 2. Date of Birth: Student's birth date in MM/DD/YY format.
• 3. Student ID Number: Student's university identification number.
• 4. Tetanus, Diphtheria vaccine: Indicate if Tdap has been given, including date.
• 5. Hepatitis B: Indicate the dates for the Hepatitis B vaccine series.
• 6. Meningococcal Vaccine: Date of initial or booster dose after the 16th birthday.
• 7. Measles, Mumps, Rubella (MMR): Dates of MMR vaccines; students born before 1957 exempted from second dose.
• 8. Poliomyelitis (OPV) or (IPV): Dates of oral or inactivated polio vaccine.
• 9. TB Screening: Date and result of the last TB test, with additional online questionnaire completion.
• 10. HPV Vaccine: Dates for HPV vaccine series (Quadrivalent, Bivalent, or Gardasil).
• 11. Hepatitis A Vaccine: Dates for the Hepatitis A vaccine series.
• 12. Meningococcal B Vaccine: Dates for the Meningococcal B vaccine series.
• 13. Varicella Vaccine: Dates for Varicella vaccine series and history of the disease.
• 14. Health Care Provider Signature: Signature and contact details of the healthcare provider who completed the form.

Failure to submit the completed JMU Immunization Form and TB Screening can result in serious consequences for students.

• Enrollment Hold: An enrollment hold will be placed on your account, preventing you from registering for classes.
• $50 Fine: A $50 fine will be charged to your student account.

• 1. New Undergraduate Students: All new undergraduate students starting at JMU must complete this form.
• 2. New Graduate Students: Graduate students attending JMU for the first time need to complete this form.
• 3. Immunization Updates: Students who need to update their immunization records can use this form.
• 4. State Law Compliance: This form ensures that students comply with Commonwealth of Virginia health requirements.
• 5. University Health Requirements: Meeting the university's health prerequisites for enrollment involves completing this form.