Please see the document guidelines below and make sure your documents are valid before uploading. Your deadline to complete the document submission is 06/06/2016.

PLEASE NOTE: THE VALIDATION PROCESS CAN TAKE UP TO 3 BUSINESS DAYS FROM THE RECEIPT OF YOUR DOCUMENTS.

CPR Certification
Must be American Heart Association Healthcare Provider, American Red Cross Professional Rescuer, or American Health and Safety Institute CPR Pro
Valid within 2 yrs, must be valid for entirety of semester entering program

Student Health Form Physical Exam
Must be on Calhoun Community College issued health form indicating “Yes” to all four statements on page 3 and signed by Healthcare Provider
Valid within 2 years

TB Testing
Must indicate either two step exam, 3 years of consecutive negatives with last being current year, or chest x ray read negative for TB
Valid within 1 year

MMR
Provide vaccination dates signed by Healthcare Provider on physical form or proof of MMR or evidence of immunity
Indefinite

Tetanus
Provide date signed by Healthcare Provider on physical form or proof of Td or Tdap
Valid within 10 years

Varicella
Documentation of 2 doses of varicella vaccine given at least 28 days apart, laboratory evidence of immunity, laboratory confirmation of disease, or diagnosis or verification of a history of varicella or herpes zoster (shingles) by a Healthcare Provider
Indefinite

Essential Functions form
Essential Functions form signed by student and Healthcare Provider
Valid within 2 Years

Hepatitis B Vaccine
Proof of Vaccinations on physical form signed by Healthcare Provider or proof or vaccination or waiver of vaccination on page 4 of physical form or evidence of immunity

Health Insurance
Valid copy of health insurance card or signed waiver of liability on page 4 of student health form. Proof of parent’s policy covering student is accepted as well.

Flu Shot
Provide date signed by HCP on physical form or proof of Flu Shot Vaccine
Valid for current season Oct-March

CDC Reference for Healthcare Providers
http://www.immunize.org/catg.d/p2017.pdf.


IMPORTANT INFORMATION REGARDING YOUR Varicella Titer/Vaccination:
Documentation of a Titer showing immunity or 2 shots, 4-8 weeks apart is required for healthcare providers (CDC.gov). You will need to submit the evidence of BOTH vaccinations to the immunization tracking link as soon as they are both complete: a physician statement, a shot record or receipt of immunization from your healthcare provider. PLEASE SUBMIT THESE AT THE SAME TIME- AFTER YOU HAVE RECEIVED DOCUMENTATION ON THE SECOND VACCINATION. The Varicella option will remain "pending" until you upload a record of both vaccinations.

Sincerely,

Calhoun Community College - MLT
    
Last Name
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Maiden Name
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Alien Authorized to work until
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gpa
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Phone Number: 555-555-5555
Position
Start Date
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Relationship
Phone: 555-555-5555
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Custom Question
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Applicants Phone: 555-555-5555
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