Immunization Records

Proof of Immunization

Louisiana Law (R.S. 17:170) requires each person entering any school within the state for the first time, shall present either:

Satisfactory evidence of immunization against vaccine-preventable diseases according to the schedule approved by the Office of Public Health, Louisiana Department of Health, or shall present evidence of an immunization program in progress; or
Sign a waiver indicating they have chosen not to be vaccinated. By completing this form you are submitting a waiver and you will not need to send us your immunization records.

Student Name*

First NameLast Name

Student Banner ID*

Student Date of Birth*

MonthDayYear

Student E-mail*

Name of College Attending*

Upload your immunization records or submit the Immunization Waiver.

Proof of immunization

Upload a File

By signing below, I acknowledge that I have read and understand the immunization requirements. I do further hereby, now and forever, free and release the Louisiana Community and Technical College System and its member institutions from any and all legal and financial responsibility.

Signature*

Please verify that you are human*