Immunization records & health forms
Complete your forms and submit to Health Services by:
- Fax: 716.338.1461 or 716.376.7021
- In person at your campus health center
Please do not submit by email.
You will be in administrative withdrawal from JCC and charged a $25 fine if you don’t turn in your forms and records.
COVID-19 vaccination, booster shot, & exemption forms
All students accessing SUNY facilities for any in-person classes or activities must be fully vaccinated against COVID-19 and receive a booster shot as they are eligible, with limited exception.
Students will submit proof of their booster shot based on their booster shot due date.
- COVID-19 Vaccination and Booster Shot Form (electronic submission)
- COVID-19 In-progress Vaccination Form (electronic submission)
- COVID-19 Medical Exemption Form (printable)
- COVID-19 Religious Exemption Form (printable)
If a student is taking online coursework only and has no plans to participate in any on-campus activities or interactions, the COVID-19 vaccination and booster shot are not required.
If a student is not fully vaccinated, or has not completed the entire vaccination process, or if you’d like to learn about how to receive a COVID-19 vaccination, visit sunyjcc.edu/covid19 to learn about specific guidelines.
MMR/meningitis form
If you are taking six or more credit hours at Jamestown Community College, you must submit to Health Services:
- MMR/Meningitis Form (electronic submission)
- Includes immunization records for measles, mumps, and rubella (MMR) and meningitis response form with your choice regarding the voluntary meningitis vaccination
Residence Life health history form
If you live in the residence halls on campus, you must also submit:
Nursing & OTA forms
Nursing and OTA programs require additional immunizations:
- Varicella (Chicken pox or positive Titer)
- Hepatitis B: Clinical sites request that you educate yourself about Hepatitis B. You are at an increased risk in the clinical setting at being exposed to Hepatitis B and other diseases. Get updated vaccination for Hepatitis B or sign the declination on your JCC health report form that you'll receive through your program.
- Tetanus
- TDAP