Certificate of Immunization for Student Health Services

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Oregon state law mandates 4 year college students* provide evidence for 2 doses of measles (rubeola) vaccine after age 12 months. There must be a minimum of 28 days between the 2 doses. Usually listed as MMR.
* born after January 1, 1957 and taking 12 or more credits (undergrads) and 6 or more credits (grads)
Yes I had 2 doses of measles (rubeola) vaccine after age 12 months. Doses were at least 28 days apart.


Born prior to 1984? If date of #1 is not available then date of #2 must be after December 1, 1989

Measles Vaccination Exemptions

Entering your name into the signature block above indicates that you certify that all information submitted is true and correct.

For questions about this form, please contact the Director of Student Health Services at studenthealthservices@cu-portland.edu