Forms

Consent to Release

The Consent to Release may be used to give authorization for disclosure of your health records to the Student Health Center OR if you need records released from the SHC to another provider or clinic. Please be aware that requests for information are processed in the order received and can take up to 2 weeks.

 

Immunization Exemption Request Forms

Proof of measles immunity and COVID-19 vaccination is required for the 21-22 academic year. If you have a medical or relgious reason that prevents you from receiving a vaccination you may submit an exemption request to the Student Health Center. Philosophical reasons will no longer be accepted exemption.

Medical Exemption (MMR and/or COVID)

Religious Exemption form (MMR and/or COVID-19)

 

Immunization Record Verification by a Health Care Professional

Immunization Record Verification by a Health Care Professional can be used if you prefer to have your Healthcare provider sign a form to verify your immunizations. This form is not needed if you have documentation of your immunizations which can be directly uploaded to the patient portal. For more information about immunization requirements please go to the Immunizations page.