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 status
SUNY campuses must continue to submit data on the vaccination status of their students. If you have received the COVID-19 vaccination, use the form below to submit your records.
For more information, visit sunyjcc.edu/covid19.
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