The Purdue immunization history form is a fillable PDF you download from the Purdue Student Health Center, complete with your vaccination dates in sections A through D, have signed by a licensed provider, and upload through the PUSH Patient Portal. You also type the dates into the portal fields after uploading. The deadline is June 30 for summer and fall students and November 30 for spring students, and missing it triggers a registration hold.
What the Form Covers
Before you open the PDF, know what dates you’re looking for. The form has four vaccine sections tied to Indiana law and Purdue policy:
- Tetanus/Diphtheria (Td or Tdap): one dose within the last ten years.
- MMR: two doses, both on or after your first birthday.
- Meningococcal ACWY (quadrivalent): one dose on or after your 16th birthday.
- Meningococcal B: two doses of the same brand (Bexsero or Trumenba), given at least six months apart.
The two meningococcal requirements are only for students age 23 or younger. If you’re 24 or older, you can leave both sections blank. Everyone else needs all four.1Purdue University Student Health Services. State Immunization Requirements for Enrolled Students
One trap worth flagging: the quadrivalent shot (Menveo or Menactra) does not satisfy the Meningococcal B requirement. They cover different strains, so you need both.
Filling Out Sections A Through D
Download the form from the Purdue Student Health Center website.2Purdue University. Purdue University Immunization History Form Every date goes in MM/DD/YY format. Pull dates directly from your medical record or your state immunization registry; don’t estimate.
Section A asks for your most recent Td or Tdap dose. Check which type it was.
Section B asks for both MMR doses. If you got the measles, mumps, and rubella components separately rather than the combined MMR shot, the form has individual fields for each.
Section C is one date: your most recent Meningococcal ACWY dose, given on or after your 16th birthday.
Section D asks for both Meningococcal B doses and the brand name. Both doses must be the same brand. Mixing Bexsero and Trumenba doesn’t count.
The form has to be completed in English. As of November 1, 2025, Purdue stopped accepting handwritten records unless they’re on this specific form; anything else you upload has to be electronic or typed.
Who Can Sign the Form
A licensed provider has to sign at the bottom to verify your dates match your records. Purdue accepts an MD, DO, NP, or RN signature.2Purdue University. Purdue University Immunization History Form Physician Assistants aren’t listed on the signature line.
If you can’t get a provider to sign the form, you have an alternative. Upload an official immunization record instead, such as a printout from your state immunization registry. It must have your full name, be in English, and be legible.1Purdue University Student Health Services. State Immunization Requirements for Enrolled Students
Submitting Through the PUSH Patient Portal
Everything goes through the PUSH Patient Portal. Log in and open Medical Clearances to reach the immunization area.
Upload your signed form or your official record. Then type each vaccination date into the portal fields. The staff won’t review your submission until both pieces are in: the uploaded document and the typed dates. If you finish a vaccine series later, use the green “update” box next to the immunization proof line to add the new record.
Check the portal in the days after you submit. If something is unclear or missing, the health center flags it in the system so you can see what to fix.
If You Can’t Find Your Records
Lost childhood vaccination records are common. Three ways forward:
- Request a printout from your state’s immunization registry. Most states maintain one for vaccines given within the state.
- Get titer blood tests for MMR. Purdue accepts titer results showing immunity, as long as the lab report includes the numeric value and reference range or states “immune” outright.1Purdue University Student Health Services. State Immunization Requirements for Enrolled Students
- Just get revaccinated. For Td/Tdap and meningococcal vaccines, a pharmacy or clinic can give you the shot and documentation the same day, which is often faster than hunting down old files.
Medical and Religious Exemptions
Indiana law allows two kinds of exemption, and both are submitted the same way as a regular immunization record: upload the statement in Medical Clearances.
For a medical exemption, a doctor or nurse practitioner writes a statement describing the condition that makes a specific vaccine dangerous for you, including the nature and expected duration and which vaccine is involved.3Indiana General Assembly. Indiana Code 21-40-5-4 – Exemption From Immunization If the condition later resolves, the exemption ends and the vaccine becomes required.
For a religious exemption, you provide a written, hand-signed, and dated statement explaining why you can’t be vaccinated. If you’re a minor, a parent or guardian also signs.4Indiana General Assembly. Indiana Code 21-40-5-6 – Religious Objections
Deadlines and the Registration Hold
Summer and fall students have until June 30. Spring students have until November 30.1Purdue University Student Health Services. State Immunization Requirements for Enrolled Students
Miss the deadline, and Purdue places a hold on your account that blocks you from registering for any future semester until the health center clears your records or accepts an exemption. Course sections fill fast during enrollment, so even a short delay in clearing the hold can cost you the classes you need.
One Note for International Students
International students have an extra requirement beyond the four vaccines: tuberculosis clearance. Purdue accepts only a QuantiFERON Gold or T-Spot blood test, not the PPD skin test, and the test has to be done in the United States within three months before classes start.1Purdue University Student Health Services. State Immunization Requirements for Enrolled Students If you’ve recently had a live vaccine like MMR, wait at least 28 days before the TB blood draw. Results go through the same Medical Clearances section, and failing to clear TB triggers the same registration hold. Domestic students don’t need the TB test.