Requirements for Students & Instructors


Below are the documents that are required to be submitted through the Clinical Facilities Form by the School's Student Coordinator:


Expires a year after initial completion. Form must have printed name and signature.

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Expires a year after initial completion. Form must have printed name and signature.

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Must be completed for each submission to gain proper AD access.


Must be completed to gain access to the Pyxis MedStation.

Required Immunizations

UCLA Health has very specific requirements for immunizations in order to be placed on the units. Instructors and students must provide all documentation to their school and the school must have these available upon request.

It is the school's responsibility to ensure that the instructors and students rotating at UCLA hospitals are tested for and free of active tuberculosis. To meet this requirement, a Quantiferon Gold, T-Spot, or " 2-Step" Tuberculin Skin Test must be completed within 3 months of UCLA student placement assignment. Students with assignments that excess 12 months, must be TB tested annually and be free of active tuberculosus at all times.

**Waiver for Immunizations are not permitted unless due to medical reasons.  

Please see Student Nurse Immunization Checklist (PDF) for the below required immunizations. 

COVID-19 Vaccination

Proof of COVID-19 Vaccination (full dose plus booster)


Letter of Exemption 

Measles, Mumps, and Rubella (MMR)

Medical documentation of TWO MMR vaccinations


Medical documentation of ONE BLOOD TITER indicating immunity to MMR

Disease history of MEASELS, MUMPS, and RUBELLA will not be accepted

 Varicella (Chickenpox)

Medical documentation of TWO VARICELLA vaccinations


Medical documentation of ONE BLOOD TITER indicating immunity to VARICELLA

Disease history of CHICKENPOX will not be accepted

Tuberculosis (TB) Screening

  • Medical documentation of TWO SEPARATE TB skin tests, One TB test must be completed within the last 3 months. The other TB test must have been completed within the last 12 months.


  • Medical documentation of a QuantiFERON Gold (also known as t-spot) blood in the last 12 months

If you have previously tested positive for TB, please provide (both):

  • Documented proof of a positive TB skin test or positive QuantiFERON Gold (also known as t-spot) blood test (documentation of positive TB from any date will be sufficient)
  • Medical documentation of a chest radiograph (chest x-ray) report within the last 3 months

Tetanus, Diphtheria, Pertussis (Tdap)

Medical documentation of Tdap vaccination


Signed Tdap declination if unable to provide medical documentation. Tdap Declination Form

Influenza Information

Flu Shot

From November 1st through March 31st, healthcare personnel must either be vaccinated for influenza or wear a mask when in direct contact with patients, providing direct patient service (within six feet), or in a patient room at Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, and UCLA Resnick Neuropsychiatric Hospital.

Students and/or instructors are not eligible to receive the free flu shot services provided by UCLA Health or redeem the CVS voucher. Flu shots must be received privately by the student and/or instructor. 

Students/clinical instructors may obtain a flu badge for the season through UCLA Health Occupational Health and present proof of flu vaccine.

Jade Cruz, MSN-Ed, RN
Nursing Professional Development Specialist
CENTER for Nursing Excellence
924 Westwood Blvd., Suite 720
Los Angeles, CA 90024
[email protected]