MMR Waiver Form For Transient Student

Transient students from another public university in Florida can submit immunization documents, or provide the Health Compliance Office with a copy of their transient form, to verify that they received the Measles and Rubella vaccines (or the MMR combined vaccine) at their home institution. This option will lift the student's MMR immunization hold temporarily for one semester.

This document serves as confirmation that I will enroll at FIU as a transient student.
To receive the waiver for this semester, I must:
1. Complete this MMR Waiver Form.
2. Provide a copy/screenshot of my transient application from Florida Shines, to verify that I have complied with the MMR Immunization requirements at my home institution.
3. Complete the Meningitis and Hepatitis B Waiver Form via my my.fiu.edu portal.

*** Waivers Forms for Hepatitis B and Meningitis Waivers: Can be found on your my.fiu.edu under: Student Tools → Student Health → Clinic → Accept ***
Today's Date: Today's Date: / MM / DD YYYY
Student Name: Student Name: First Last
Panther ID:
Date of Birth: Date of Birth: / MM / DD YYYY
Email:
Phone: Phone: - ### - ### ####
This form will be valid for ONLY the semester referenced below.
Please select term:
Year of Starting Semester:
Home Institution:
I understand this temporary hold removal is valid for ONLY one semester. If I would like to permanently remove this hold, I would have to submit valid immunization records to immune@fiu.edu.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Provide proof of Transient Student Application from Florida Shines (ex.copy/screenshot )

Attach Files

MMR Waiver Form For Transient Student

MMR Waiver Form For Transient Student

This form will be valid for ONLY the semester referenced below.