Health Services Immunization and Form Requirements

WHAT WHO WHEN SUBMIT TO
First MMR after one (1) year of age All entering degree-seeking students Prior to the end of the first semester of on-campus attendance Submit via e-form (see instructions below)
Second MMR at least twenty eight (28) days after date of first MMR All entering degree-seeking students Prior to the end of the first semester of on-campus attendance Submit via e-form (see instructions below)
TB skin test (Mantoux) or IGRA blood test (Quantiferon Gold or T-Spot TB) International students only Prior to checking into the residence halls or first day of attendance in class (whichever is earlier) Submit via e-form (see instructions below)
Counseling Intake Form All students seeking counseling services Before your first visit with a CSC Licensed Student Counselor The CSC Licensed Student Counselor you see
Informed Consent Form All students seeking counseling services Before your first visit with a CSC Licensed Student Counselor The CSC Licensed Student Counselor you see
Chadron Medical Clinic Consent to Treat a Minor Form Any student under the age of 19 Before your first visit with the CSC Campus Clinic Nurse nurse@gxitma.net
See our Immunization Instructions for tips to submit your immunization records via your MyCSC account.

Health Services Form Exemptions

CSC offers a medical, religious, and temporary exemption from immunization requirements. For more information regarding immunization exemptions, please refer to the Immunization Policy. Waiver forms are located within the immunization e-form on your MyCSC account.

Health Services Immunization Recommendations

Other immunizations recommended for students but not required for admission:

  • Hepatitis B vaccination (series of three (3) shots)
  • Varicella vaccination if no history of chicken pox (series of two (2) shots)
  • Influenza vaccination (yearly) offered through CSC Health Services at a reduced cost each fall
  • Meningococcal vaccination available through either CSC Health Services or Chadron Medical Clinic
  • Human Papillomavirus (HPV) vaccination (a series of three (3) shots)
  • Tetanus Diphtheria booster every ten (10) years after initial series of three (3) DPT vaccinations
    • One (1) adult booster should also contain pertussis

Tips about Immunization Records

  • Where to search for your immunization records:
    • Ask your parents or guardian
    • Ask your most recent high school, middle school, or college.
    • Ask your medical provider or vaccination clinics
    • Ask your VA or your branch of the military
  • CSC Immunization Records
    • Digital copies of immunization records are kept for 5 years after the last semester of enrollment
    • Immunizations are also entered into the Nebraska Immunization Database

Have a question about immunization requirements and compliance? Email cschealthrequirements@gxitma.net or call (308) 432-6232.