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Dear Member of the Class of 2028,

Based on the recommendations of the Advisory Committee on Immunization Practices (ACIP), New Jersey state law requires each new student entering a four-year college or university receive information about meningococcal disease and meningococcal vaccine. Details regarding meningococcal disease and the vaccine can be found at http://www.cdc.gov/meningococcal/index.html.

According to the ACIP, "college freshman, particularly those who live in dormitories, are at modestly increased risk for meningococcal disease relative to other persons their age." Additionally, the ACIP concludes, "the risk for meningococcal disease among non-freshman college students is similar to that for the general population."

Rowan-Virtua SOM students do not fit this profile of "college freshman living in a dormitory,” as there is no Rowan-Virtua SOM student housing available on the Stratford or Sewell Campuses. However, it is important for you to read this information and complete the survey.

Student Health Services are provided by Charise Emery in the Rowan-Virtua SOM Department of Family Medicine. You may contact her at emeryc1@rowan.edu to find out about the availability and cost of the vaccine if you choose to receive it.

Sincerely,

Anne C. Jones, DO

Assistant Dean for Student Affairs

Student First Name

Student Last Name

Student Date of Birth (use XX/XX/XXXX)

I have received information about the nature of meningococcal meningitis disease, disease prevention and treatment, and the availability of meningococcal vaccine to prevent disease.

Meningococcal Vaccine (Select one)

I have already received the meningococcal vaccine, below please include date received or month/year:
I have decided not to receive the meningococcal vaccine.
I plan to receive the meningococcal vaccine now or in the future.
I am undecided about receiving the meningococcal vaccine.

Student Signature

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