Submit Immunization Documents

Three easy ways to obtain your immunization documents

  1. Physician’s Office: Ask your physician to submit your immunization documents to NYIT Office of Wellness Services. The form must be clearly stamped by your doctor’s office.
    Need a form? Use NYIT’s immunization form or your physician can send their own version.

  2. School Counselor: State law requires your high school to maintain your health records. Just ask your school counselor to provide them to you or submit them directly to NYIT Office Wellness Services. If you are a transfer student, you can ask your college to send your records our way.

  3. Department of Health: Need immunizations? Visit your local Department of Health. Please check the New York City Immunization Walk-In Clinic Website.

How to Complete

  1. Scan your documents or download the two (2) PDF forms below.
  2. Make sure your documents are completed, signed, and stamped by a health care provider.
  3. Submit to NYIT via the online form below or have them emailed, faxed, or mailed.
  4. If required, you may email or fax immunization documents, or mail to Northern Boulevard, P.O. Box 8000, Old Westbury, NY 11568-8000.

    Long Island campus
    Adelaide Marciano
    Student Activities Center, Room 319
    Email: amarcian@nyit.edu
    Phone: 516.686.7976
    Fax: 516.686.1410

    New York City campus
    Yahaira Ruiz
    33 W. 60th St., Room 308
    Email: yruiz@nyit.edu
    Phone: 212.261.1770
    Fax: 212.261.1772

Submit Forms

Are you an F1 or J1 visa student arriving from a country listed on the Student Tuberculosis Testing Form?*

PDF only / 100MB Max

PDF only / 100MB Max

IMPORTANT
These forms will not be accepted if the required information is not completed by a health care provider.

Part III of the Student Immunization Form has been completed by a health care provider. The form has been signed and stamped by a health care provider.*

Sections 1, 2, and 3 of Student Tuberculosis Testing Form have been completed by a health care provider. The form has been signed and stamped by a health care provider.*

Note: letters are case-sensitive.