Search
Frequently Asked Questions Services A to Z NJHome
Department's Home Page NJHome
 

Annual Immunization Status Report

arrow Minimal Immunization Requirements For School Attendance In New Jersey [word 30k] [pdf 27k]
arrow Instructions for Completing the On-Line Annual Immunization Status Report [pdf 27k]
* Required Fields
*School ID: - -
NOTE: Please add a leading zero to your id, if your label shows 8 digits.
*County: *Muncipality Code:
School District:
*Name of School/ Child Care Facility:
If Facility Recently Changed Name, List Previous Name:
Mailing Address:
*Street:
*City: *Zip Code:
School Address (if different from above)
Street:
City: Zip Code:
 
*Name of Person Completing the Form: *Telephone:
School Email Address:
Name of Principal/ Person in Charge: Title:
*Total School/Child Care Center Enrollment:
*Elementary/ Secondary School/Child Care Facility: Public Non-Public Head Start Preschool/ Nursery/ Day Care


The school is responsible for assuring that all pupils are in compliance with the New Jersey Immunization requirements. In the boxes below, enter the status of all pupils in your entry level grade, grade 6, and transfer students (any grade).

  • Child care facilities must enter the immunization status of all enrolled children who are over 2 months of age on the pre-k line
  • If your school has pre-kindergarten classes, enter those children on the pre-k line.
  • If your school has a kindergarten grade, enter those children on the kindergarten line.
  • Do not include data in the grade 1 boxes unless the student is beginning school for the very first time in grade 1.
  • All pupils entering grade 6 record on the grade 6 line.
  • Ungraded special education pupils should be included with the appropriate age cohort class.

Grade Level Not Applicable Pupils Meeting All Immunization Requirements +Pupils with Provisional Admittance Pupils with Medical Exemptions Pupils with Religious Exemptions Pupils with Status Unknown
Pre-k:
Kindergarten:
Grade 1:
Grade 6:
**Transfer Students
(Out of State/Country only):

+ Provisional Admittance - those pupils who have begun or are in the process of completing all the required immunizations.

** Transfer Students - all students newly transferred into grades K-12 from any out-of-state/ out-of country school since submission of last year's status report.

   


Department of Health and Senior Services

P. O. Box 360, Trenton, NJ 08625-0360
Phone: (609) 292-7837
Toll-free in NJ: 1-800-367-6543
Our Locations
Privacy policy, terms of use and contact form links State Privacy Notice legal statement DHSS Feedback Page New Jersey Home


OPRA- Open Public RecordAct
department: njdhss home | index by topic | programs/services
statewide:njhome | services A to Z  | Departments/Agencies | FAQs
Copyright © State of New Jersey, 1996-

Last Modified: Thursday, 03-Apr-08 16:27:31