Meningitis Waiver

What is Meningitis?
Meningococcal disease caused by a bacterial infection can lead to bacterial meningitis, a severe swelling of the brain and spinal cord, or sepsis, a life-threatening blood infection. Each year. the disease strikes about 1500 people in the United States. Sometimes meningococcal disease can be difficult to diagnose or treat because the initial symptoms are similar to the flu or an upper respiratory infection. The infection progresses very rapidly and can cause death in 48 hours or less. Survivors of meningococcal infections can suffer permanent brain damage, hearing loss, amputations or kidney failure.

Who is at risk?
College students, especially those living in college dorms, have a higher risk for meningococcal disease.  There is a 6-times greater chance of catching this disease for college students living in residence halls for the first time.  The bacteria that causes meningococcal disease is contagious and spreads by an exchange of respiratory secretions through kissing, sharing drinks or food or a cough from a person who has the bacteria.

How can you protect yourself?
Making sure you have been vaccinated against meningococcal disease is the most effective way to protect yourself.  WSU Student Health Services strongly recommends that students living in University housing receive a meningitis vaccination to protect themselves and prevent the spread of this contagious disease. If you have not received the vaccine, Student Health Services at WSU has the vaccine available for currently enrolled students. Find out more on our website www.wichita.edu/shs.

Meningitis vaccination policy at Wichita State

Each first-time resident of a University residence hall shall be required to submit one of the following:

a. Proof of Meningitis Vaccination within fifteen (15) days of occupancy of a University residence hall.  This documentation must be in the form of an official vaccination record.
b. A completed Meningitis Waiver Form indicating their knowledge of the risks of bacterial meningitis and their refusal to be vaccinated.  

Any first-time resident who does not complete and submit proof of meningitis vaccination or a Meningitis Waiver Form within fifteen (15) days of occupancy of a University residence hall shall be referred to the Associate Vice President for Student Engagement and Dean of Students and may have a hold placed on their student records. Students can submit their vaccination records to Student Health Services via mail, fax (see below) or at the Student Health office located at 209 Ahlberg Hall. For questions, call Student Health Services at 316-978-3620 or Housing and Residence Life at 316-978-3693.

Click Here for additional meningitis information.


I have read the above information and do not wish to receive the meningitis vaccination.

I do not wish to participate

Students who do not submit this waiver must submit a shot record.  Shot records may be emailed by clicking here or faxed to Student Health Services at 316-978-3517.


Type student’s name: (By typing your name you consent that this electronic signature is valid and will hold you to all terms and conditions.)

Student’s myWSU ID:

Student’s Date of Birth:


Parent Signature:(Parent’s signature required if student is under 18; by typing your name you consent that this electronic signature is valid and will hold you to all terms and conditions in this contract.)