SJCC Health Immunization Form

REQUIREMENTS: MMR VACCINE and TB SCREENING

All SJCC international students are required to provide evidence of having received vaccination against Measles, Mumps and Rubella (MMR) on or after their first birthday. One dose of MMR is adequate for an adult. Students in the health care provider industry are at higher risk and need documentation of two doses. A recent tuberculin skin test (within one year) is also required.

If you cannot demonstrate proof of the above, schedule an appointment with SJCC Student Health Services (SC-109) or with your own medical professional.

To schedule an appointment with SJCC Student Health Services, please call 408-288-3724. Please note: appointments are only available starting on the first day of the semester.

Necessary items to bring to your appointment:

This Health Immunization Form
Picture ID (Student ID, Passport, Driver’s license)
Proof of class registration (Available in your MyWeb or Self-Service Portal)
Any previous immunizations records (MMR and BCG)
TB skin testing resulting if you have them
All documents should be in English and/or have English translations

Testing for TB in BCG – Vaccinated Persons

The BCG Vaccine (TB Vaccine) may help protect young children from getting very sick with TB. This protection goes away as people get older. People who have had the BCG vaccine still can get latent (hidden) TB infection and active TB disease. If you had the BCG vaccine and you have choice of having a TB blood test (IGRA) or TB skin test (TST), although either test can be used, it is best for you to have the TB blood test. This is because the TB blood test is not affected by the BCG vaccine. This means that your TB blood test will be “positive” only if you have the TB bacteria in your body.

For more information please visit http://www.cdc.gov/tb/topic/basics/default.htm or contact the Santa Clara County Public Health Department.

Source: Santa Clara County Public Health Department: Tuberculosis (TB) and Latent TB Infection FACT SHEET

Last Name

First Name

Date of Birth

Date

Student ID number

Email

example@example.com

Next Steps:
Print this form and bring with you to your appointment with a medical professional to complete and sign.

Schedule an appointment with a medical professional.

Submit this form when it is completed and sigend by a medical professional to the SJCC ISP office.

Submit Completed Forms Here:
SJCC ISP F-1 Updated Documents Submission Form (link)

Or drop it off in GE-118

DO NOT EMAIL documents to the ISP office.