What you should know about CSUEB Immunization Requirements

The California State University Board of Trustees requires that: ALL STUDENTS born on or after January 1, 1957 must show proof of full immunization against measles (rubeola) and rubella. Certain groups of students regardless of age must also show proof of full immunization. These groups include: students who attended K-12 school outside the US, students who will live in the campus residence hall, and/or students who will work with pre-school age children or health care patients as part of their college experience. All new enrollees who are 18 years of age or younger must show proof of having completed a 3 dose series of immunizations against Hepatitis B.

Immunity to Measles (Rubeola) and Rubella means:

Two doses of measles and rubella given individually or in combination (MR or MMR) at or after 12 months of age and at least one month apart.

Immunity to Hepatitis B means:

Three doses of Hepatitis B vaccine given over a period of approximately 6 months.

Compliance with these requirements can be met in the following ways and needs to be completed prior to your next registration period:

A. Submit Documentation

Send one or more of the following documents to the Student Health Services with your name and Student ID# clearly indicated on each document submitted:

• The form on the reverse side (or similar form) completed by your physician or health care provider
• A photocopy of your childhood immunization record
• A photocopy of your California High School transcript IF immunization information is documented on transcript
• A copy of a lab report showing proof of immunity by blood titer

B. Be Immunized

If you don’t have documentation, be immunized at:

• Your family physician
• A local clinic or County Public Health Department
• CSU, East Bay Student Health Center once you are an enrolled student

C. Request a waiver or exemption

• Medical: If your medical circumstances contraindicate immunization, have your physician sign the statement on the reverse side of this form (or similar form) and return it to the Health Center.
• Religious: State law permits exemption from immunization for those who object to immunizations on religious or personal grounds.

D. Student Statement of Exemption

If you were born prior to January 1, 1957, and attended K-12 in the US, will not reside in a campus residence hall (dorm), and will not work with pre-school age children or health care patients as part of your college experience, please sign the student statement of exemption (# 5b) on the reverse side of this form.

Mail or FAX your completed forms and documentation to:

California State University, East Bay
Student Health Services – Immunizations
25800 Carlos Bee Blvd.
Hayward, CA 94542-3060
FAX: (510) 885-3230

Immunization Form

Immunization Requirements and Verification Form (MS Word format)

Healthy Bodies, Healthy Minds!