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.

Meningococcal disease is a severe bacterial infection of the bloodstream or meninges (a thin lining covering the brain and spinal cord).

Anyone can get meningococcal disease, but it is more common in infants and children. For some college students, such as freshman living in dormitories, there is an increased risk of meningococcal disease. Between 100 and 125 cases of meningococcal disease occur on college campuses every year in the United States; between 5 and 15 college students die each year as a result of infection. Currently, no data are available regarding whether children can be in settings similar to college freshman living in dormitories. Other persons at increased risk include household contacts of a person known to have had this disease, and people traveling to parts of the world where meningitis is prevalent.

The meningococcal germ is spread by direct close contact with nose or throat discharges of an infected person. Many people carry this particular germ in their nose without any signs of illness, while others may develop serious symptoms. High fever, headache, vomiting, stiff neck, and a rash are symptoms of meningococcal disease. Among people who develop meningococcal disease, 10-1 5% 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. The symptoms may appear two to ten days after exposure, but usually within five days.

Treatment for meningococcal disease includes antibiotics, such as penicillin G or ceftriaxone. Also, a safe and effective vaccine is available. The vaccine is 85% to 100% effective in preventing four kinds of bacteria (serogroups A. C, Y, W-135) that cause about 70% of the disease in the United States. The vaccine is safe, with mild and infrequent side effects, such as redness and pain at the injection site lasting up to two days. After vaccination, immunity develops within seven to ten days and remains effective for approximately three to five years. As with any vaccine, vaccination against meningitis may not protect 100% of all susceptible individuals.

For more information about meningococcal disease, contact your family physician 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.