Find detailed directions on where to return forms and contact information for assistance at the bottom of this page.

School/Childcare Request to Change Site Administrator Form

Request a change in site administrator for an existing school/childcare site.

School/Childcare New Site Form

Establish a new MCIR site for a school or childcare.

School/Childcare Building Name Change Request Form

Request a building name change for an established school/childcare site in MCIR.

School/Childcare Petition to Modify MCIR Data Form

Use this form to correct spelling, modify DOB or sex, or merge duplicate records. The parent/legal guardian must request a legal name change.

Consent for Disclosure Form

Consent form template for disclosure of personally identifiable information and immunization information to local and state health departments.

Weekly Communicable Disease Report Form

Report communicable diseases to the local health department as required by Public Act 368. Completed forms should be sent to the local health department.

School Aggregate Report Form

Use this form for students not reported in MCIR/SIRS. Completed forms should be sent to the local health department.

School Aggregate Report Tip Sheet

Childcare Aggregate Report Form

Use this form for children not reported in MCIR/SIRS. Completed forms should be sent to the local health department.

Childcare Aggregate Report Tip Sheet

Health Appraisal Report Form

Provide this form to parents/legal guardians to be completed by a medical provider so the school can work with the parent to meet the child’s physical, intellectual, and emotional needs.

Employer Site Usage Agreement Addendum

Complete this form to request access to an employee’s MCIR immunization records to verify vaccination status with employee consent.

Postsecondary Education Institutions Roster Application

Request access to MCIR records as a postsecondary education institution.

Local Health Department School/Childcare Contacts

Contact your county’s local health department school/childcare coordinator for help with reporting requirements, training requests, and waiver information.

Return Completed Request to Change Administrator, New Site, Building Name Change, and Petition to Modify MCIR Data Forms: (please allow up to 3 business days for processing):
Email: MDHHS-MCIRHelp@michigan.gov
Fax: 517-763-0370

Return Communicable Disease Report and Aggregate Report Forms to your county’s School and Childcare Local Health Department Contact.

Questions about reporting requirements, waiver information, and requests for MCIR/SIRS training should also be directed to your Local Health Department Contact.

For technical assistance with MCIR or form questions, contact the MCIR Help Desk:
Phone: 888-243-6652
Email: MDHHS-MCIRHelp@michigan.gov
MILogin: 877-932-6424, option 5 for password reset

MCIR Help Desk Hours of Operation:
Phone: Monday – Thursday 10AM – 12PM and 1PM – 4PM
Email: Monday – Friday 8AM – 4:30PM