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Health Services Center

Immunization Policy Details | JSU Immunization Form

All students admitted to Jackson State University   are required to submit proof of having received two immunization shots for measles, mumps, and rubella (MMR) in order to complete registration for classes.

If an applicant has already been admitted and plans to attend the University as a first time student (undergraduate, graduate or transfer), he/she must submit a copy of the required immunization record to the University Health Center prior to registration for courses.

Students who have been admitted but do not submit the required immunization verification will be unable to complete registration for classes in the school’s computer enrollment system.

The University Health Center will accept any immunization document that shows proof that the student has had the two MMR shots (measles, mumps, rubella) and has the same identifying information required on most immunization compliance forms (see JSU Immunization Form link on web page)

  • Your name, address, date of birth
  • Dates that the two MMR shots were given (month, day, year)
  • Name, address and phone number of verifying health care facility or provider


Applicants can also download and print the JSU Compliance Form and have their healthcare provider complete and sign it or use the Mississippi Form 121 or their own state’s standard compliance form.
All immunization documents can be submitted in one the following ways:

FAX TO:   601-979-9228  


P.O. BOX 17097
JACKSON, MS  39217


IN PERSON:  Immunization documents may be dropped off to the University Health Center located on Prentiss Street near the Prentiss Street entrance (FLAT TOP ONE STORY BUILDING WITH BLUE TRIM AROUND THE TOP, RECTANGULAR SHAPE).

(For more detailed information about JSU’s immunization policy including exemptions, alternative blood test as proof, immunization forms etc, go to “Immunization Policy Details” link above.)

For questions, the Health Center can be contacted by email at

Health Services Center


1400 John R. Lynch St.
PO Box 17097
Jackson, MS 39217

Phone: 601-979-2260
Fax: 601-979-9228