Health History Form
Health history forms must be completed and signed by the student’s healthcare provider by June 30.
- Step 1: Read your Welcome Letter Summer ’17 for important dates and information!
- Step 2: Complete pages 2-3 of your 2017 Student Health Form and have your healthcare provider complete page 1 OR attach an official copy of your vaccination records to your health form.
- Step 3: Fax or mail your completed Health Form and vaccination records to the Student Health Center by June 30.
PLEASE NOTE: Failing to complete this form in time will result in a medical hold that will restrict you from registering for classes for next semester.
Immunization requirements, based on recommendations of the American College Health Association, are required for every full-time day undergraduate student and any residential student (graduate or other programs).
Required vaccinations include:
- 3 doses of DPT and tetanus booster (preferably Tdap) within the last 10 years;
- 2 doses of MMR (measles, mumps, rubella) vaccine if born after 1956 OR positive blood tests tests for IgG titers;
- 3 doses of hepatitis B vaccine or a positive blood test for hepatitis B surface antibody titer;
- 2 doses of Varicella if born after 1979, history of chickenpox disease, or a positive blood test for Varicella IgG titer;
- Tuberculosis testing (PPD, T-Spot, or Quantiferon Gold) for all nursing majors, education majors, and students living in high risk countries (S. America, C. America, Africa, Asia, E. Europe and parts of W. Europe);
- Meningococcal Meningitis Vaccine(Type A, C, W-135, Y) or a signed waiver of declination;
- Type B Meningitis Vaccines is recommended but not required.
Most vaccines are available at cost from the Student Health Center.