Skip To Main Content

Immunizations and Health Assessment Transmittal Form

Immunization Requirements

Required Immunizations:

As required by North Carolina Statute (G.S. 130-A-152 (a)), all Union Academy students must have a complete record of immunizations on file signed by a physician or bearing a physician’s stamp. 

Parents will be notified in writing when their child does not meet immunization requirements. The law allows parents or guardians 30 calendar days from the first day of the child’s attendance to present the required up-to-date immunization records. Upon termination of the 30-calendar-day period, the child shall not be permitted to attend school until he or she provides a Certificate of Immunization as required by law.

5 DTP, DtaP, or DT doses (if 4th dose is after 4th birthday, 5th dose is not required)
4 PCV (no individual 5 years of age or older is required to receive PCV)
4 Polio doses (if 3rd dose is after 4th birthday, and 6 months after 3rd dose, 4th dose is not required.)
1-4 HIB doses (series complete if at least 1 dose given on/after 15 months and before 5 years of age; not required after age 5.)
3 Hepatitis B doses (Children born on or after July 1, 1994 are required to have 3 doses.)
2 Measles doses (on/after 12 months of age, and doses must be at least 28 days apart)
1-2 Mumps doses (1st dose on/after 12 months of age, 2nd dose required if entered K on/after 7/1/08)
1 Rubella dose (on/after 12 months of age)
1-2 Varicella dose (required if born before 4/1/01, 2nd dose not required if entered K before July 1, 2015)
1 Tdap dose (all rising 7th grade students or 12 years of age whichever comes first)
2 MCV dose (all rising 7th grade students or 12 years of age, whichever comes first, all rising 12th grade students or 17 years of age , whichever comes first)

**To claim a religious exemption, the parent or guardian must date and sign a statement that includes: their religious objection to the immunization(s), as well as, name and date of birth of the student for whom the exemption is being requested.

**To claim a medical exemption, the parent or guardian must submit a letter from a physician who is licensed to practice in North Carolina. This letter must certify that the specified vaccine is detrimental to the student's health and include both the student's name and date of birth.

It is the responsibility of the parent/guardian to provide the school with a record of the completed immunizations prior to the first day of school. The documentation must come from a physician’s office, health department, or state immunization registry. Please submit this documentation to the school nurse. For more information regarding immunization requirements for entry to school, visit NCDHHS.


Immunization Requirements for Rising 7th Graders:

Immunization Letter for Rising 7th Graders

Meningococcal ACWY Vaccine

Tdap (Tetanus, Diptheria, Pertussis) Vaccine


Immunization Requirements for Rising Seniors:

Immunization Letter for Rising Seniors

Meningococcal ACWY Vaccine


Recommended Vaccines:

Influenza (Flu) Vaccine

HPV (Human Papillomavirus) Vaccine

Meningococcal B Vaccine

Health Assessment Transmittal Form Information

All children entering Kindergarten or public schools for the first time are required to present the completed North Carolina Health Assessment Transmittal form on or before the first day of attendance. Health Assessments must be completed within one year prior to a student’s enrollment. 

Health Assessment Requirements General Statute


Useful Links:

North Carolina Rules and Laws Regarding Immunizations

North Carolina K-12 Immunization Requirements

CDC Immunization Schedules