Immunization Form
Before you are allowed to register for classes, the college must receive your immunization records.

Connecticut State Law requires that all full-time (degree seeking and non-degree/non-matriculating) and part-time matriculating students enrolled in post-secondary schools and born after December 31, 1956 be protected against measles, mumps, rubella and varicella.

Measles, Mumps and Rubella
Students must have two doses of measles, mumps & rubella vaccine at least 28 days apart with dose number one given on or after the first birthday to ensure adequate immunization.

Varicella (Chicken pox)
All students born after December 31,1979 must also show evidence of immunization for varicella. Students must show two doses of the vaccine administered at least one month apart to ensure adequate immunization.

Students may present serologic (blood test) evidence in place of vaccinations to verify immunity, or a physician's or municipal health director's certification of the date that the student was diagnosed with the disease.


If a medical reason prohibits you from being vaccinated, Option 3 of the Immunization Form must be signed. The form must be returned to Admissions along with documentation or an explanatory note from the attending physician.

If inoculation is contrary to your religious beliefs or practices, Option 4 of the Immunization Form must be signed and the form returned to Admissions.

In the event of an outbreak of measles, mumps, rubella or varicella on this campus, students who are not in compliance with the immunization requirements will be excluded from classes until their immunizations are complete.

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Copyright Quinebaug Valley Community College
742 Upper Maple Street • Danielson, CT 06239 • (860) 932-4000
729 Main Street • Willimantic, CT 06226 • (860) 336-0900

Copyright Quinebaug Valley Community College