Immunization Form

Minnesota Law (Minn. Stat.135A.14) requires students enrolled in a public or private post-secondary school in Minnesota to be immunized against tetanus and diphtheria (Tdap/Td). The most recent vaccination must have been within the last ten years.
Minnesota Law (Minn. Stat.135A.14) also requires students be immunized against measles, mumps and rubella (MMR). All doses of MMR vaccine must have been received after the age of 12 months.
Students are exempt from this law if they were born before 1957, graduated from a Minnesota high school after 1996, enrolled in one class and not housed on campus or enrolled in online classes only.
To provide this information, students must complete an Immunization Form within the first 45 days of classes. Without this form, you will not be able to register for subsequent semesters. Please note that holds are not immediately removed.

Name(Required)

First Middle Last

Birthdate(Required)

Institution(Required)

Bemidji State University

Northwest Technical College

Student I.D. Number(Required)

Your Student I.D. is an 8-digit number that was assigned to you when you were admitted to NTC.

Email(Required)

Phone(Required)

Please check the appropriate category(Required)

Graduated from a Minnesota high school after 1996

Born before 1957

Enrolled in only one class, and NOT housed on campus

Enrolled in online or off-site classes only

None of the above

If you would like to complete a Medical and Conscientious Exemptions Form, please fill it out and secure the information and signatures required. The form can be found on the Confirmation page when you submit this form. If you are non exempt, please fill in the dates below.

Measles (rubeola, red measles), Mumps, & Rubella (German Measles)(Required)

Tetanus, Diphtheria & Pertussis (Tdap) or Diphtheria (Td)(Required)

Needs to be within 10 years.

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