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Health & Wellness Center | Mandatory Immunization Form

Immunization Record

This for must be completed by your health care provider in order to register for classes.  It must be submitted prior to the beginning of the semester you first enroll at Trinity.

The District of Columbia requires that every student who is under the age of 26 at the time of registration be immunized from the following diseases.

Required Immunizations

  • Three (3) doses of DPT in childhood and a booster of Tetanus/Diphtheria (TD) within the last 10 years.
  • Two (2) doses of measles/mumps/rubella (MMR) after 12 months of age, at least 1 month apart
  • Hepatitis B (3 doses)
  • Meningitis Vaccine- 2 doses
  • Varicella Two (2) doses or a History of Chicken Pox
  • Three (3) doses of polio vaccine
  • Tb screening test within the past 12 months

Recommended Immunizations

  • Hepatitis A
  • Human Papilloma Virus (HPV)


Please download the form below and have your medical provider fill out the required information and either hand deliver, Fax (202-884-9614), or Scan and email your form to

Mandatory Immunization Record-2016-17

Mandatory Meningitis Vaccine Information

For more information contact the Health and Wellness Center at 202-884-9615.



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