Health Form

Saint Mary's College requires each student to accurately complete a medical history and immunization record (i.e. health form). You may pick up a Health Form at the Health Center or download a printable pdf copy below. The completed Health Form may be mailed to: the Health Center, 50 Holy Cross Hall, Notre Dame, IN 46556, or faxed to 574-284-4833.

Immunization Requirements are:

  • M.M.R. (Measles, Mumps, Rubella)
    • Two doses of measles, mumps, and rubella (MMR) vaccine no less than one month apart.
    • Proof of a positive serologic test for measles, mumps, and rubella.
  • Tetanus-Diphtheria (Primary series with DTaP or DTP and booster with Td in the last ten years.
  • Meningococcal Vaccine Preferably receive the vaccine. If opt against must read Meningococcal information and sign that you have read information and choose to refuse.
  • Varicella

Other recommended immunizations include: Tetanus/Diphtheria Series and a booster within the past 10 years, Polio Series, Hepatitis B Series, Hepatitis A Series, and Varivax, if you have not had a Chicken Pox vacination. College students are also encouraged to consider being vaccinated for bacterial meningitis, a contagious disease that can cause serious health problems and which can be life threatening.

Students will be allowed one semester to provide this information to the Health Center and if it is not provided by then, further registration may not be allowed until proof of such immunization is provided. Exemptions for religious beliefs can be granted based on written requests. Exemptions for health reasons are also accepted when verified by a medical provider.