This form has a maximum of 10 pages
Dear Student,
Congratulations on your acceptance to Wentworth! As part of your paperwork for enrollment, Massachusetts law requires all full time college students to be fully immunized and provide supporting documentation. The State also requires that you read the additional information regarding bacterial meningitis and sign the waiver attached if you choose not to receive the meningitis vaccine. Your immunization records may be available from your physician, high school, or previous college. If your immunization records are not available or incomplete, you will need to demonstrate immunity through blood tests, or you will need to be immunized again.
Incoming students, both residential and commuter, MUST have this complete form submitted in order to move onto campus or to pick up laptops.
Please be advised that a full medical physical is not required by the Center for Wellness.
Immunization Form Instructions
1. Students must complete page 1; read pages 3 and 4; and complete page 5 (if applicable).
*Please write your Wentworth ID# on all submitted papers
2. Physician/Health Care Provider must complete and sign page 2.
*Please do not attach additional forms in lieu of completing page 2.
3. Students must return the completed Immunization Form to Wentworth by July 1, 2016
4. Mailing address:
Wentworth Institute of Technology
Center for Wellness and Disability Services
550 Huntington Ave.
Boston, MA 02115
If you would prefer to fill this form in offline, then please download the following blank PDF form, and post it back to us at the address above.
