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Credit Transfer Evaluation Guidelines

• The sending institution must be regionally accredited at the higher education level.
• The coursework to be transferred must be comparable in nature, content, and level to courses offered in the declared program major.
• Contact a transfer specialist East Grand Forks Campus
• Contact a transfer specialist Theif river Falls Campus

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NCTC International Students

NCTC Immunization Record for Students Attending Post-Secondary Schools

Please print, complete and sign this form and send to:
Online Minnesota
Box 309
Perham, MN 56573, USA

Student Name:____________________________
(Last, First, MI)
Birthdate:___________________
Social Security Number:___________________
Date of Enrollment:___________________

Minnesota Law (M.S. 135A.14) requires proof that all students born after 1956 and enrolled in a public or private post-secondary school in Minnesota be immunized against diphtheria, tetanus, measles, mumps, and rubella, allowing for certain specified exemptions (see below). This form is designed to provide the school with the information required by the law and will be available for review by the MinnesotaDepartment of Health and the local community health board.

____ Check here if you were born before 1957 for the age exemption. All other students who are not age-exempt: Complete parts 1, 2, and 3.

PART I : Students graduating from a Minnesota High School in 1997 or later. I have previously met the MMR & TD requirements because I graduated from a MN High School in 1997 or later.
Student's Signature:___________________	Date:___________________
High School Name:___________________	City:___________________	Graduation Date:___________________

PART II : Students who graduated from a Minnesota High School prior to 1997 or students from out-of-state.	Mo/Day/Yr	Mo/Day/Yr	Mo/Day/Yr
Tetanus/Diphtheria (Td) (must be within the last 10 yrs)
Measles/Mumps/Rubella (MMR) (given after 12 months of age)
Hepatitis B (persons at increased risk should have completed a 3-dose series)
I certify that the above information is a true and accurate statement of the dates on which I was vaccinated. Student's Signature:	Date:___________________

PART III : Other Exemtion(s) Students wishing to file an exemption from any or all of the required immunizations must complete the following: Medical Exemption:

The student named above does not have one or more of the required immunizations because he/she has: (check all that apply & fill in the appropriate blanks)
____ a medical problem that precludes the ______________________________________vaccine(s).
____ not been immunized because of a history of __________________________________ disease.
____ laboratory evidence of immunity against _______________________________________ .
Physician's Signature: ________________________________Date: _________

Conscientious Exemption: I hereby certify by notarization that immunization against the student named above is contrary to his/her conscientiously held beliefs.
Student's Signature: ______________________________Date: _________
Subscribed and sworn before me on the ________day of ____________, ________
Notary's Signature: ______________________________Date: _________