Immunizations Forms | Notifications
On 6/13/19, Public health law section 2164 was amended, eliminating the exemption from vaccinations due to religious beliefs for school attendance. Please visit the Immunization Page on this website for additional information.
2019-20 NYSDOH Immunization Requirements Chart
2019-20 Immunization Requirements for School Attendance Chart NYSDOH (3/2019)
Documentation/Tracking Forms for Immunizations
Letters to Parents/Guardians for 2019-2020 immunizations for students by grade
- Immunization Requirements for Students Entering PreK- Grade 12 in the 2019-20 School Year. You may wish to include a copy of the Immunization Requirements Chart. (6/2019)
- Immunization Requirements for Students Entering Pre-K in the 2019-20 School Year (6/2019)
- Immunization Requirements for Students Entering Grades K-5 in the 2019-20 School Year (6/2109)
- Immunization Requirements for Students Entering Grades 6-11 in the 2019-20 School Year (6/2019)
- Immunization Requirements for Students Entering Grade 12 in the 2019-20 School Year (9/2019)
- Meningococcal Vaccine Requirement for 2019-20 School Year (6/2019)
Sample Medical Exemption Letters/Forms
- NYSDOH Dear Colleague letter regarding guidelines for use of immunization-related medical exemptions for school-aged children Provides guidelines for use by health care practitioners- to assist them in determining the appropriate use of immunization-related medical exemptions for school-aged children as well as providing a sample form for their use, and to assist school personnel with assessing accurate completion of medical exemption paperwork. (NYSDOH, 2016)
- NYSDOH Immunization Requirements for School Attendance Medical Exemption Statement for Children 0-18 Years of Age Sample External link to the NYSDOH form for NYS physicians requestion medical exemption from immunization for their patients. This form must be completed annually. (NYSDOH, 5077 6/16)
- Sample Medical Exemption Approval Letter with Notification of Exclusion During Communicable Disease OutbreakThis sample letter may be customized to inform parents/guardians that their child has that in the case of an outbreak, their child would be excluded for the length of contagion. Ideally, this information should be communicated when the exemption is granted. (NYSCSH, 9/2019)
Sample Exclusion Letters
Exclusion Letter for Principal to Send to Parents- Provides a sample that principals can customize to send letters to parents whose children have not received the required immunizations for school attendance (NYSCSH, 12/2016).
Updated 10/21/19
