Graduate Student MMR Immunization Form

This form allows you to electronically submit proof of your immunity to measles, mumps, and rubella (typically in the form of two doses of the MMR or comparable vaccine). Mississippi state law requires that students provide proof of this immunity. Please be aware that if you upload records that do not indicate immunity to the above diseases, we will continue to request proof of immunity.

If you have any questions about the immunization requirement, please contact Student Health Services at 601.266.5348.

Name*

First Name

Middle Name

Last Name

Student ID # *

Your USM Email *

Please upload proof of immunity to the measles, mumps, and rubella in the form of shot records indicating two doses of the MMR vaccine, a positive titer test, or proof of previous infection. *

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