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****please indicate all dates based on the USA system of Month/Day/Year Berkeley College Student Immunization Record Form Name: ___ Home Address: ___ Date of Birth: ___ month/day/year___ State Laws require postsecondary students to show protection against MEASLES, MUMPS, and RUBELLA plus MENINGITIS for dormitory students in New Jersey. REQUIRED: Measles (Rubeola) Immunity Must have ONE of the following: 1
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