Health Services Forms

Required Immunization Form

To comply with New York State regulations, please complete the following MMR and Meningitis Immunization Form.

Measles, Mumps, and Rubella (MMR)
New York State Public Health Law requires that full- and part-time students submit proof of immunity to measles, mumps, and rubella.

Meningococcal Meningitis Vaccine

New York State Public Health Law requires all college and university students to either receive the vaccination against Meningococcal meningitis, or acknowledge that they have been made aware of the risks and have chosen not to be vaccinated.

What is Meningococcal disease?
Meningococcal disease is a severe bacterial infection of the bloodstream or meninges (a thin lining covering the brain and spinal cord). It is caused by the meningococcus germ.

Who gets Meningococcal disease?
Anyone can get Meningococcal disease, but it is more common in infants and children, followed by a second peak in adolescence. Infants less than one year and adolescents ages 16 through 23 years have higher rates of contracting the disease than other age groups but cases occur in all age groups, including the elderly. For some adolescents, such as first-year college students living in residence halls, there is an increased risk of Meningococcal disease.

How is the meningococcus germ spread?
The meningococcus germ is spread by direct close contact with nose or throat discharges of an infected person. Many people carry this germ in their nose without any sign of illness but others may develop serious symptoms.

What are the symptoms?
High fever, headaches, vomiting, a stiff neck and a rash are symptoms of meningococcal disease. The symptoms may appear two to 10 days after exposure but usually within five days. Among people who develop meningococcal disease, 10 to 15 percent die, in spite of treatment with antibiotics. Of those who live, permanent brain damage, hearing loss, kidney failure. loss of arms or legs, or chronic nervous system problems can occur.

What is the treatment for Meningococcal disease?
Antibiotics, such as penicillin G or ceftriaxone, can be used to treat people with Meningococcal disease.

Is there a vaccine to prevent Meningococcal meningitis?
There are three vaccines available for the prevention of meningitis. The preferred vaccine for people ages 2-55 years is the Meningococcal conjugate vaccine (MCV4). This vaccine is licensed as Menactra (Sanofi Pasteur) and Menveo (Novartis). The Meningococcal Polysaccharide vaccine (MPSV4), Menomune (Sanofi Pasteur), should be used for adults ages 56 and older. The vaccines are 85 to 100 percent effective in preventing the four kinds of the meningococcus germ (types A, C, Y. W-135). These four types cause about 70 percent of the disease in the United States. Because these vaccines do not include type B, which accounts for about one third of cases in adolescents, they do not prevent all cases of Meningococcal disease.

Who should get the Meningococcal vaccine?
The vaccine is routinely recommended for all adolescents ages 11-12 years and all unvaccinated adolescents 13-18 years. For adolescents who receive the first dose at age 13-15 years, a one-time booster dose should be administered preferably between the ages of 16 and 18 years.  There is no need to wait 5 years from the first dose before administering the booster. Rather, give the booster dose any time at or after the 16th birthday. Eight weeks is the minimum interval between doses.

The booster dose is not recommended for adolescents who receive their first dose of Meningococcal vaccine at or after their 16th birthday as long as they have no risk factors. All college freshman living in a dormitory are recommended to be fully vaccinated. You must document that you received the meningitis vaccine to live in one of our residence halls.

How do I get more information about Meningococcal disease and vaccination?
Contact your family health care provider or your student health service. Additional information is also available on the websites of the New York State Department of Health, the Centers for Disease Control and Prevention  and the American College Health Association.

Recommended Physical Exam Form

Please present the Report of Medical History to the Physician or N.P. during your physical examination.

Accident and Health Insurance
The College automatically covers all full-time undergraduate students with a limited accident insurance policy that is in effect 24 hours a day, 52 weeks a year, both on and off campus.

Effective as of August 1, 2014, all international students enrolled at the College on a full-time basis are required to have health insurance coverage in the United States. Proof of coverage must be submitted to the Office of Student Accounts by September 1 of each year. Any full-time international student who has not submitted documentation of comparable coverage will be enrolled in and charged for the health insurance provided by the College.

Domestic students cannot purchase the College’s health insurance plan for international students. Domestic students who are not covered through their parent’s/guardian’s plan should consult the Health Insurance Exchange Marketplace for coverage information.