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  • REQUEST INFO
  • APPLY
  • ACADEMICS
    • UNDERGRADUATE PROGRAMS
      • Audio Recording Technology
      • Business Administration
      • Business Management
      • Film and Television
      • Interactive Media Arts
      • Liberal Arts
      • Mass Communication
      • Music Teacher Education
      • Music Performance
      • Theatre Arts
    • GRADUATE PROGRAMS
      • Sound Recording Technology
      • Music Education
      • Master of Music
      • Doctor of Musical Arts
    • ACADEMIC RESOURCES
      • Online Education
      • Five Towns College Catalog – 2021-22
      • Registrar
      • Academic Standards
      • Student Success Center
      • The Writing Center
      • FTC Bookstore
      • Academic Calendar
      • College’s Student Learning Assessment
  • ADMISSIONS
    • UNDERGRADUATE ADMISSIONS
      • How to Apply: Undergraduate
      • Online Application
      • Early Action College Application Process
      • Higher Ed Opportunity Program (HEOP)
      • L.I. Superintendent’s Scholarship
      • Summer High School Scholars Initiative
      • Guidance Counselors
      • Accepted Students
      • Orientation
      • FAQ
    • GRADUATE ADMISSIONS
      • Online Application
      • Graduate Music Studies Incentive
      • Fellowship Performance Initiative
      • Adult and Continuing Education
    • ADMISSIONS RESOURCES
      • Open House Events
      • Campus Visit
      • For Parents
      • For Transfer Students
      • For International Students
      • For Veterans
      • Request Information
      • Zoom Information Sessions
  • FINANCIAL AID
    • OVERVIEW
      • Financial Aid Overview / Consumer Information
      • Apply for Financial Aid | FAFSA Application
      • Grants, Loans, Scholarships and Veterans’ Benefits
      • Federal Work Study | Work Study Application
      • SAP Requirements
    •  DETAILS: TUITION & FORMS
      • Tuition and Fees
      • Payment Plans
      • Links and Forms
      • Upload Financial Aid Documents
  • STUDENT LIFE
    •  CURRENT STUDENTS
      • Calendars
      • Current Students
      • Career Services Center/Alumni Assoc
      • Student Success Center
      • Student Access & Disability Services
      • Clubs and Organizations
      • Enough is Enough
      • Things To Do On Long Island
    • ATHLETICS
      • Men’s Basketball
      • Men’s Soccer
      • Men’s Volleyball
      • Men’s Cross Country
      • Women’s Basketball
      • Women’s Soccer
      • Women’s Volleyball
      • Women’s Cross Country
      • FTC SOUND LIVE! Stream
      • Sound Esports
  • ABOUT US
    • ABOUT FIVE TOWNS COLLEGE
      • College Mission Statement & Goals
      • College Accreditation
      • Administration
      • Consumer Info / Student Right To Know
      • Faculty
      • Fast Facts
      • FTC News: The Record Online
      • Directions
    • CAMPUS FACILITIES
      • On-Campus Housing
      • Campus Dining
      • FTC Performing Arts Center
      • The John Lennon Center
      • Information Technology Office
      • FTC Campus Store
      • Library
      • Public Safety
    • ADDITIONAL RESOURCES
      • Administrative Office Contact Info
      • Employment Opportunities at FTC
      • Institutional Policies
      • Health Testing Info & Records
      • Public Health Bulletins
      • Featured Alumni
      • Testimonials
  • REQUEST INFO
  • APPLY

Vaccination Response Form

Vaccination Response FormDaoning Dai2020-08-14T13:29:24-04:00
  • Meningococcal Meningitis Vaccination Response Form


    New York State Public Health Law 2167 requires that all college and university students enrolled for at least six (6) semester hours or the equivalent per semester, or at least four (4) semester hours per quarter, complete and return the following form to Five Towns College.

    Check one box and sign below.

  • MM slash DD slash YYYY
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  • Student Mailing Address

Five Towns College

305 North Service Road,
Dix Hills, NY 11746
Phone: 631.656.2110
Fax: 631.656.2172

If you're serious about music, business, education, media
and the performing arts . . .
Come to Long Island!


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