Wisconsin Immunization Program

Immunization Requirements

• 2009-10 School Age/Grade Reqs.
  (English) (PDF, 26 KB)  (Spanish) (PDF, 24 KB)  (Hmong) (PDF, 24 KB)
• 2008-09 School Age/Grade Reqs.
  (English) (PDF, 63 KB)  (Spanish) (PDF, 16 KB)  (Hmong) (PDF, 16 KB)
• Varicella, Tdap, and PCV (Pneumococcal) School Requirements
• School Based Clinic Consent-Tdap/Varicella
  (English) (PDF, 55 KB)  (Spanish) (PDF, 29 KB)  (Hmong) (PDF, 29 KB)
• School Based Clinic Consent-Tdap only
  (English) (PDF, 26 KB)  (Spanish) (PDF, 26 KB)  (Hmong) (PDF, 26 KB)
• Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Varicella, Meningococcal Conjugate (MCV4) and/or Human Papilloma Virus (HPV) Vaccine(s)
  (English) (PDF, 29 KB)
 (Spanish) (PDF, 130 KB)  (Hmong) (PDF, 34 KB)
• Letter to School Principals (PDF, 44.3 KB)
• School Fact Sheet for Parents
  (English) (PDF, 56 KB)  (Spanish) (PDF, 30 KB)  (Hmong) (PDF, 27 KB)
• Student Immunization Record
  (English) (PDF, 46 KB)  (Spanish) (PDF, 52 KB)  (Hmong) (PDF, 52 KB)
• 2008-2009 Wisconsin School Immunization Requirements Booklet (PDF, 827 KB)
• 2008 Day Care Assessment Booklet (PDF, 732 KB)
• Day Care Fact Sheet for Parents (PDF, 24.8 KB)
• Day Care Immunization Record (PDF, 83.3 KB)
• School Report to Local Health Department (PDF, 21.1 KB)
• School Report to the District Attorney (PDF, 9.5 KB)
• Chapter DHS 144 Immunization of Students (exit DHFS; PDF, 37.5 KB)
• Wisconsin Statute 252.04 (exit DHS; PDF, 105.1 KB).
  The Immunization portion can be found on pg. 2 of the document.
• Chapter DHS 124 Hospitals (exit DHS; PDF, 178.8 KB)
• History of Wisconsin Student Immunization Law

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Last Revised: June 25, 2009