Mandatory Immunization Requirements for
Colorado School of Mines Students
Fall Semester Deadline – July 1st
Spring Semester Deadline – January 1st
ALL incoming students MUST submit the following items to the CSM Student Health Center by the above deadlines:
Health History (Only to be completed if student is under age 18. Parent signature is required on this form and all other forms as indicated for under age students)
Certificate of Immunization (with physicians signature, OR official immunization record from school, physician, government or military)
Meningococcal Disease (if living on campus)
Please PRINT and mail completed forms to the following address. Forms MAY NOT be submitted electronically to the Student Health Center.
CSM Student Health Center
1770 Elm Street
Golden, CO 80401
The Health History form provides the Health Center Staff with information about the patient’s health history, including allergies, past health concerns, and family history. This information helps the staff provide the student with proper treatment.
Colorado state law requires new freshman, transfer and graduate students submit proof of two doses each of measles, mumps and rubella vaccines (or two doses of the combined MMR vaccine). This is a mandatory requirement for all college students born on or after January 1, 1957. Both doses must be given on or after the student’s first birthday.
Please complete the form and attach an official copy of your immunization record OR take the form to your healthcare provider to complete and sign. You may obtain an official record of your immunizations from a previous school, physician or the military.
Please see below if you cannot provide valid proof of MMR immunization (under “FAQ”), or if you wish to exempt yourself from immunizations for personal, medical or religious reasons.
The risk for exposure to Tuberculosis is assessed, and must be completed by all students.
Due to the increased incidence of meningitis among college students, Colorado state law requires that all students residing in student housing be provided with the information about Meningococcal Disease. The most recent Meningococcal immunization should be listed on this form and documented on the official record of immunization. If the student's Meningococcal vaccine was given prior to age 15, a booster is recommended. The duration of the vaccine is three to five years. If the student chooses to waive this immunization, please be aware that should an outbreak of the disease occur while the student resides on campus, he/she may be quarantined.
Upon a student’s bona fide request and submission of appropriate documentation, CSM may grant a waiver of the immunization requirements. Students who choose to sign personal exemptions should be aware that they will not be able to obtain any immunization from the Health Center during their time on campus. Exemptions for religious or medical reasons will require documentation from either the student’s religious leader or a health care provider.
Please be aware than should an outbreak of any one of these diseases occur on campus, the student may be asked to refrain from attending classes until the outbreak has resolved.
Student athletes participating in NCAA athletics must provide these forms to the Health Center in addition to meeting the requirements of the CSM Athletics Department.
How should the forms be completed if the student is younger than 18 years of age?
Please have a parent or guardian sign the “consent to treat” at the bottom of the first page. Until this is signed (or the student turns 18), the student will be unable to receive treatment from the Health Center.
What if I can’t provide proof of MMR immunization, even though I’ve had the vaccines?
Contact previous schools, the military or previous health care providers to obtain immunization records. If proof of immunization cannot be obtained, there are two options: you may choose to obtain a blood titer to prove immunity to all three diseases (measles, mumps and rubella) or you may choose to receive both vaccines again.
What if I’ve never had an MMR vaccine, or if one was received before my first birthday?
You will need two valid MMR doses (or one dose, if one was received after your first birthday), both of which are available at the Health Center. Due to the recent Measles outbreak, it is highly recommended that you receive at least one MMR prior to your arrival at school.
What if I miss the deadline for form submission?
A hold may be placed on the student’s Trailhead account if forms are not submitted by the due date.
What if I have a more specific situation than mentioned here?
Please, feel free to call the Health Center at 303-273-3381 with any questions—we are more than happy to help!