Meningococcal Vaccine  

Proof of receipt of the Meningococcal Vaccine (Menactra) or waiver is required of all freshmen Sierra College Students who will be residing in the Residence Halls beginning fall semester 2005.

Please complete the following:

I have received the meningococcal vaccine (Menactra).

Date of vaccination: _______________

Attach proof of vaccination or physician signature.

Physician Signature: ______________________ Date: __________________

Physician Name (printed): _____________________ Phone No. _____________