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Executive MBA Enrolled
New York NYU Stern EMBA

COMPLETE MMR AND MENINGITIS FORMS 



The table below summarizes what is needed, from whom it is needed, and what action should be taken.  The first four items are due by Thursday, December 15, 2011.  If you need more information, a detailed explanation of each item is described below the table next to the corresponding number.


 NYU Medical Requirements Who should submit? Action Item
1. MMR Form
Required for all students born after December 31, 1956.
Download, print, complete, and submit to Laura (212/998-0784; ldeffley@stern.nyu.edu).
2. Meningitis Waiver
Required for all students.
Download, print, complete, and submit to Laura (212/998-0784; ldeffley@stern.nyu.edu).
3. Health Insurance Information
Required for all students.
Fill out form 1.
4. Detailed Proof of Insurance ONLY required for those in U.S.A. on F or J visas Contact Laura (212/998-0784; ldeffley@stern.nyu.edu).
5. Student Health History Form Required for all students. Will be distributed during orientation check-in on Sunday, January 8, 2012.  Must return to Executive MBA staff member by Friday, January 13, 2012.

 

 

1. MMR Immunization Form
You must download, print, complete and submit to Laura (212/998-0784;
ldeffley@stern.nyu.edu
).

 

New York State law requires that students attending colleges and universities within the State prove immunity to measles, mumps, and rubella (MMR). The law applies to ALL students born after December 31, 1956. (If you were born before 1957, you are exempt from this requirement.) NYU takes the issue so seriously that you will not be allowed to attend class at Stern after the residency unless you are in full compliance with the law. You must be in at least temporary compliance before you attend the residency beginning on January 8, 2011.

 

You must prove that you have either received the proper vaccinations or are immune (as shown by a blood titre). Having had the disease, even if documented by your doctor, is not sufficient evidence of immunity without a substantiating blood titre. If you do not have proof of immunity, you must receive two doses of the vaccine, at least one month apart. Please plan ahead so that your second shot will occur before December 15, 2011. Vaccines may be given by a number of sources, including:

  • your personal, company, or family physician
  • a clinic operated by the New York City Department of Health
  • Boards of Health in other communities

Please note that this issue can take time to resolve and you should begin the process as soon as possible. Additionally, having attended a college or university within New York State previously does not necessarily mean that you are in compliance with current laws. The laws regarding MMR immunization have changed significantly in the last 5-10 years and now require more shots and/or more substantial proof of immunity than in previous years.

For more information please visit the NYU Health Center website.

If you have questions regarding these requirements, contact Laura Deffley (212/998-0784; ldeffley@stern.nyu.edu).

 

2. Meningitis Form
You must download, print, complete and submit to Laura (212/998-0784; ldeffley@stern.nyu.edu
).

Those students who are exempt from MMR requirements are NOT exempt from the Meningitis requirement.

New York State has a law regarding meningococcal disease, a potentially fatal bacterial infection commonly referred to as meningitis.

The law requires that all New York State colleges and universities distribute information about meningococcal disease and vaccination to all students (whether they live on or off campus). According to New York State Public Health Law, all students registered for 6 or more credits are required to decide whether or not to be immunized and to provide formal confirmation of their decision.

New York University is required by this law to collect from every student a completed and signed “Meningococcal Meningitis Vaccination Response Form,” confirming receipt of meningococcal disease vaccine information.

Please note that the Meningococcal Meningitis vaccination is not required; however, we must receive a signed response form from you.

For more information please visit the NYU Health Center website.

If you have questions regarding these requirements, contact Laura Deffley (212/998-0784; ldeffley@stern.nyu.edu).

 

3. Health Insurance Information

Complete the required health insurance information section on form 1 by clicking here.

It is a University policy that all students must have health insurance to attend any program at NYU. If you are not already covered by a health insurance policy of your or your spouse’s organization, you must purchase NYU Student Health Insurance.

For more information and to enroll, please visit NYU Student Health Insurance.

 

4. ONLY for those in the U.S.A. on F or J visas

Due to government regulations, detailed proof of valid insurance coverage is required from all students who are in the U.S. on F or J visas, as differences in coverage often arise. You must have the minimum level of insurance required for all University students. NYU provides quality insurance at relatively low cost.  For more information and to enroll, please visit the NYU Student Health Insurance webpage by clicking here.

If you are on an F or J visa and would not like to purchase NYU insurance, provide Laura with all of the following four items as proof that you are insured:

  • A memo from you to NYU requesting a waiver of school insurance because you are covered by your firm’s policy, spouse’s policy, or other insurance
  • Proof of valid insurance coverage
  • Confirmation of dates of coverage
  • Description of coverage in English, using U.S. dollars

(A photocopy of your insurance ID card or the coverage confirmation letter from your insurance carrier which will normally have the above information). We will provide you with a NYU waiver form to complete, once you have returned the above four items.

We must have this documentation in our office prior to February 10, 2012, or you will be charged for the University’s insurance, regardless of other coverage. You will be responsible for this charge, as it is not included in your tuition. It is impossible to reverse this charge once it has been applied, since it also entails “de-enrolling” you from the insurance plan. We urge you to provide the requested information immediately—or to enroll in insurance now.

Note: you will be required to submit this documentation again for the 2012-13 academic year.

If you have questions regarding these requirements, contact Laura Deffley (212/998-0784; ldeffley@stern.nyu.edu).  


5. Student Health History Form
We will provide you with the form during your orientation at the residency on Sunday, January 8, 2012. You will need to return it to a member of the Student Services Team by the end of the residency on Friday, January 13, 2012.

All new students must complete the Student Health History form.

 

If you have questions regarding these requirements, contact Laura Deffley (212/998-0784; ldeffley@stern.nyu.edu).