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Rev.

11 (2010-11-19)

Dear Student,

Please understand that you will not be permitted to register for class or reside in FDU housing until the health forms and immunization records are completed and received. Completed health forms are due: July 15th for Fall December 1st for Spring April 15th for Summer NOTE: If you are a non-matriculating student, in a certificate program, or are a conference participant, you are exempt from the requirements.

Enclosed you will find the required health forms (6 pages). Please complete the Student Profile, Medical History, and Meningitis Response Form yourself. Your health professional will need to complete the Physical Examination and the Immunization Record forms. To assure your safety and that of your classmates, the N.J. Department of Health requires evidence that you have received two measles vaccinations and at least one vaccine for both mumps and rubella after your first birthday, or proof of immunity to all three diseases through a blood test. The New Jersey Department of Health requires evidence that you have received three doses of the Hepatitis B series. The N.J. Department of Health also requires that all new students, who reside in University housing, receive the meningitis vaccine as a condition of enrollment.

The Student Health Services staff welcomes you to the University and we offer our support in any way possible during your study at Fairleigh Dickinson University. If you have special needs or require assistance with a medical problem, please do not hesitate to contact us before your arrival.

Medical records are strictly confidential and are used exclusively by the Student Health Service to provide personalized care. Immunization records are an exception and are not confidential since your immunization status must be made available to state inspectors and select University offices in order to comply with New Jersey state law. We strongly recommend that you keep a copy of your immunization records. Your cooperation is greatly appreciated. For more information about immunization and medical requirements and/or to download the required forms, please visit our website at http://alpha.fdu.edu/wellness. Please forward your original completed Medical forms to the proper address below. Student Health Services (SHSMetro) FDU: Metropolitan Campus 1000 River Road, T-SU2-03 Teaneck, New Jersey 07666-1914 (201) 692-2437 Wellness Center FDU: The College at Florham 285 Madison Avenue, M-WE0-01 Madison, New Jersey 07940-1006 (973) 443-8535 Vancouver, Canada

Madison, New Jersey

Teaneck, New Jersey

Wroxton, England