Updated August 11, 2016
All Rutgers University–New Brunswick undergraduate students are required to submit either verification of each meningitis B vaccine dose received or sign a declination form containing information about meningococcal disease prevention and vaccination. Completed forms can be returned two ways:
By email: email@example.com
57 US Highway 1
New Brunswick, NJ 08901
Meningitis B Vaccination Verification Forms
Meningitis B Vaccination Form Packet Individual Pages
- MenB Vaccination Form Instructions (PDF)
- Meningitis B Vaccination Information and Trumenba® Dose Tracker (PDF)
- MenB Vaccination Documentation Form for Dose #1 of Trumenba® (PDF)
- MenB Vaccination Documentation Form for Dose #2 of Trumenba® (PDF)
- MenB Vaccination Documentation Form for Dose #3 of Trumenba® (PDF)
- Alternate MenB Vaccine Documentation Form for Dose #2 and Dose#2 of Bexsero® (PDF)
- MenB Vaccination Declination Form (PDF)*
* What Does Declination Mean?
If you choose not to get or complete the recommended meningitis B vaccine, it means you are declining the vaccine and are required to submit a declination form to Rutgers Student Health. We understand that students may choose to decline the vaccination for a variety of reasons, including medical or religious reasons. However, we urge you to take this health advisory seriously. Meningitis B can be deadly within hours or days of getting sick. It can also lead to severe disabilities, such as loss of limbs. If you plan to decline due to concerns about payment, insurance, finding the vaccine, or any other logistical issue, please contact Student Health to see if we can help.
Some things to keep in mind about declination:
- You only need to submit a declination form if you choose not to receive or complete the vaccination series.
- If you receive vaccination at your doctor’s office or local pharmacy, that is not declining. However, you need to submit a verification form after each dose.
- If you submit a declination form and then change your mind, that’s fine! You will still be able to receive the vaccination series.
- If you’ve been unable to begin the vaccination series this summer but plan to attend one of our on-campus clinics, you do not need to submit a declination. However, you need to submit a verification form after each dose.
You can contact Rutgers Student Health at firstname.lastname@example.org or 848-932-7402.