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MMR Form

Measles, Mumps, Rubeola Vaccination Documentation

In order to comply with Oregon law regarding a second dose of Rubeola (hard measles) vaccination for college students, Lewis & Clark requires that all graduate students born after January 1, 1957, complete and submit vaccination information. Option three may require additional documentation. Any required documentation can be emailed or mailed separately. (The form does not allow you to upload documents.)


Complete ONE of the following three options below and submit.

OPTION 1. I have had two doses of measles vaccine on or after my first birthday and they were given at least thirty days apart.

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Date of my second dose of vaccine was:
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I understand that if I choose a non-medical exemption, I am required to provide Lewis & Clark a Vaccine Education Certificate.
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