Most states require children to have vaccines against 7 to 10 diseases before entering kindergarten, with additional boosters required around 7th grade and sometimes for college enrollment. The exact list varies by state, but a core set of vaccines is nearly universal across the U.S. Here’s what you need to know at each stage.
Vaccines Required for Kindergarten Entry
While each state sets its own rules, almost every state requires the same foundational vaccines for children entering kindergarten or first grade. These protect against the diseases that spread most easily in classroom settings:
- DTaP (diphtheria, tetanus, pertussis): 5 doses, with the final dose typically given between ages 4 and 6. A fifth dose isn’t necessary if the fourth was given at age 4 or later.
- Polio (IPV): 4 doses, with the final dose at age 4 or older.
- MMR (measles, mumps, rubella): 2 doses. The first is given around 12 to 15 months, and the second between ages 4 and 6.
- Varicella (chickenpox): 2 doses for school-age children. The first at 12 to 15 months, the second at 4 to 6 years.
- Hepatitis B: 3 doses, starting at birth and completed by 18 months.
Many states also require hepatitis A (2 doses) for kindergarten entry, though this is less universal. A smaller number of states have added other vaccines to their lists. The CDC recommends vaccines for all of these diseases plus several others, but state law determines what’s actually mandatory for enrollment.
What Changes in Middle and High School
A second wave of requirements hits around ages 11 to 12, typically tied to 7th grade entry. Two vaccines are most commonly required at this stage:
The Tdap booster is a single dose that refreshes protection against tetanus, diphtheria, and pertussis (whooping cough). It replaces the childhood DTaP series. Most states require it for 7th grade enrollment. Kids who miss it at 11 or 12 can get a catch-up dose anytime through age 18.
The meningococcal ACWY vaccine protects against bacterial meningitis, which spreads more easily among teenagers in close contact. The CDC recommends a first dose at 11 to 12 and a booster at 16. Many states require at least one dose for middle school entry, though the booster requirement at 16 is less consistently mandated.
College Enrollment Requirements
At least 22 states require a meningococcal vaccine for college students, with most focusing on students living in dormitories. Campus housing creates the kind of close-quarters environment where meningitis outbreaks are more likely, and college-age students face slightly higher risk than their peers who aren’t on campus.
Beyond state law, many colleges and universities set their own vaccine policies. These institution-specific requirements can include MMR boosters, varicella, hepatitis B, and sometimes meningococcal B (a different strain than the ACWY vaccine given in middle school). Check your school’s health services page directly, since these policies often go beyond what state law requires.
How Requirements Vary by State
There is no single national vaccine mandate. Each state decides which vaccines to require, how many doses, and what exemptions to allow. Some states require hepatitis A for kindergarten while others don’t. A handful require annual flu shots for younger children in licensed childcare. The differences can be significant if you’re moving between states or enrolling a child mid-year.
Your state health department’s website will have the definitive list. Searching “[your state] school immunization requirements” will typically bring up the exact form your school district needs.
Exemptions and How They Work
All 50 states and Washington, D.C., allow medical exemptions for children who have a genuine contraindication to a specific vaccine, such as a severe allergic reaction to a vaccine component or a compromised immune system. These require documentation from a healthcare provider and are sometimes limited to specific vaccines rather than covering the entire schedule.
Beyond medical exemptions, the landscape splits. Most states offer religious exemptions, while a smaller number also permit philosophical or personal belief exemptions. The process varies considerably. Some states require notarization of exemption forms. Several mandate that parents review educational materials about vaccine benefits and the risks of skipping immunization before the exemption is granted. Many states also require parents to acknowledge that exempted children can be excluded from school during a disease outbreak.
Exemptions are typically vaccine-specific, meaning you may need to indicate exactly which vaccines the exemption covers rather than opting out of the entire schedule.
Chickenpox: When Prior Infection Counts
Varicella is one of the few required vaccines where proof of past infection can substitute for vaccination. If your child had chickenpox, a healthcare provider can verify the diagnosis and document it as evidence of immunity. The provider needs to confirm either a direct link to another confirmed chickenpox case or lab results from the time of illness.
A parent simply saying “my child had chickenpox” isn’t sufficient. Without an epidemiologic link to a confirmed case or lab confirmation, the CDC considers the history unverified, and vaccination is still recommended. Blood tests showing immunity are also accepted as proof.
If Your Child Is Behind on Vaccines
Children who missed vaccines or started the schedule late don’t need to begin the entire series over. The catch-up schedule allows compressed timing between doses to get kids current as quickly as possible. For example, the two MMR doses can be given just 4 weeks apart during catch-up, and the two varicella doses need only 3 months between them. Hepatitis B can be completed in as little as 16 weeks from the first dose.
Most schools allow a short grace period, often 30 days, for new students to provide documentation or begin catching up. Some states issue conditional enrollment, letting children attend while they complete a catch-up series on a defined timeline. Your school’s registrar or nurse can explain the specific policy.
What Documentation You’ll Need
Schools require an official immunization record, not just a parent’s recollection. The accepted format depends on your state. Georgia, for example, requires a specific state Certificate of Immunization form on file for every student through 12th grade. Other states accept printouts from the state immunization registry or signed records from a healthcare provider.
If you’ve lost your child’s records, your pediatrician’s office, your state’s immunization registry, or the clinic where the vaccines were given can usually provide copies. Many states maintain digital registries that your provider can access.
Getting Vaccines at No Cost
The federal Vaccines for Children (VFC) program covers all recommended childhood vaccines for kids under 19 who are uninsured, enrolled in Medicaid, American Indian or Alaska Native, or underinsured (meaning their insurance doesn’t fully cover vaccines). Children with private insurance that covers vaccinations are not eligible.
If your child is underinsured, VFC vaccines are available through federally qualified health centers and rural health clinics. For insured children, the Affordable Care Act requires most health plans to cover recommended vaccines with no copay. Local health departments also commonly offer school-required vaccines at low or no cost, particularly during back-to-school clinics in late summer.