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 Home » Student Services, Dean of Students » Immunization Form

Immunization Form

Minnesota Law (M.S. 135A.14) requires that all students born after 1956 and enrolled in a public or private post-secondary school in Minnesota be immunized against diphtheria, tetanus, measles, mumps, and rubella, allowing for certain specified exemptions. This form is designed to provide the school with the information required by the law and will be available for review by the Minnesota Department of Health and the local community health board.

View the immunization form in Adobe Acrobat .PDF format.

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For more information, contact:

Judy Hedman
Dean of Students office
Northwestern Hall 120

Stop by in person or e-mail your form to: stdntsrv@luthersem.edu