Vaccination & TB Form Immunization Requirements As required by the State of Missouri, Tuberculosis Testing is mandatory if you fall in one of the high risk categories listed above. TB Skin Test or Chest X-Ray: Students must have a TB skin test dated within the last 12 months or proof of chest x-ray demonstrating negative TB results. This is an annual requirement for students enrolled at Avila University. Please complete the TB screening form if the following does NOT apply to you. I am from, were born in, or have visited for more than 2 months Asia, Africa, Central or South America, Caribbean, Eastern Europe, or Oceanic/Pacific Islands. I have been diagnosed with a chronic medical condition that may impair my immune status. I am or have been a health care worker. I have been a volunteer or an employee of a nursing home, prison, homeless shelter, or other residential institution. I have close contact with someone who has or previously had active TB. Students can upload electronic copies of their immunization records using this form First NameMiddle NameLast NameStudent ID NumberEmail AddressBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900 Please read each option below and check ALL that apply: Please read each option below and check ALL that apply: Lived for 2 or more months in Asia, Africa, Central or South America or Eastern EuropeBorn in Asia, Africa, Central, or South America or Eastern EuropeBeen a health care worker in any settingVolunteered or worked in a nursing home, prison or other residential institutionHad recent contact with a person known to have active TuberculosisIf selected one or more of the above options, please submit your records belowPlease upload a copy of your shot records. Submit
