Incoming Student Requirements:
The following two forms are required of all incoming undergraduate, international and Health Sciences students.
Student Immunization Record (PDF)
Medical History Record (PDF)
Please note: Both forms must be complete and turned in to Health Services in order to register for classes. If you are missing just one part (i.e. a Tdap), you will have a "Health History Hold" until your file is complete.
Medical History Record
3-page self-report form, filled out and signed by the student. No need
for doctor signature.
Please Note: This is NOT the "Medical History Form" athletes have to fill out for Athletics.
Student Immunization Record
- Part One: Filled out by the student
- Part Two: Documentation of (a) 2 MMRs (usually given around 1 year and 5-10 years old); and (b) a Tetanus, Diphtheria, & Acellular Pertussis vaccine (Tdap). International students must also have a current
PPD completed in the U.S.
Documentation can be provided in a number of ways:
Part Three: Recommended immunizations.
- Your Health Care Provider can fill in the form;
- Copy of shot card or official documentation;
- Copy from high school (i.e. official transcripts or Certificate
- Copy of current college's form.
- If you do not have any of the above options, you may receive a blood test (Rubeola, Rubella, and Mumps Titers) to prove MMR immunity and update your Tetanus-Diphtheria.
- Part Four: Travel Immunizations. Travel immunizations are not required. However, if you participate in a cross-cultural experience, you may need the documentation. Sometimes it is easier to ask a healthcare provider for all your immunizations at once, rather than in pieces during deadlines.