Student Health Data- Immunization

Diphtheria, Tetanus, Pertussis (DTP/DTaP)

Pre-Kindergarten and Kindergarten

• Have received 4 doses of DTP/DTaP at the recommended intervals with the last dose received on or after the fourth birthday.

Grades 6, 7, & 8 

• Have received one dose of Tdap on or after 11 years of age.

Haemophilus influenzae type b (Hib)

Students less than 5 years old (Pre-Kindergarten)

• Have received the series of Hib vaccines.

Hepatitis B

 Pre-Kindergarten and Grades 6, 7, & 8

• Have received 3 doses of Hepatitis B vaccine at the recommended intervals.

Meningococcal conjugate (MCV4)

Grades 6, 7, & 8

• Have received 1 dose of meningococcal conjugate vaccine (MCV4) on or after 11 years of age.

Pneumococcal

Students less than 5 years old (Pre-Kindergarten)

• Have received the pneumococcal vaccine according to the PCV schedule.

Polio

Pre-Kindergarten

• Have received 3 doses of IPV at the recommended intervals.

Kindergarten

• Have received 4 doses of IPV at the recommended intervals with the last dose received on or after the fourth birthday.

Varicella (Chicken Pox)

Pre-Kindergarten 

• Have received 1 dose of varicella vaccine after the first birthday. 

Grades K-8

• Have received 2 doses of varicella vaccine with the first dose on or after the first birthday.

Measles (Rubeola) German Measles (Rubella, 3 Day) Mumps – (MMR)

Pre-Kindergarten

• Have received 1 dose of MMR vaccine after the first birthday.

Grades K-8

• Have received 2 doses of MMR vaccine with the first dose on or after the first birthday.

Must fill out the Illinois Certification of Religious Exemption (download here), and have a physician sign it. Please bring the completed form to your school health office.

Must be a signed statement from a licensed physician stating what the specific medical condition of the child is that makes the administration of one or more of the required immunizations medically contraindicated.