New students who are age 19 or older must complete this form; students who are younger than 19 must have this form completed by a parent or guardian.
Information shared on this form will be kept confidential and will be shared with appropriate College personnel on a need-to-know basis only.
The following documents are necessary to complete this form:
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Student’s immunization record (copy uploaded to computer)
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A list of surgeries and significant illnesses
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A list of the student’s medications
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Health insurance card (copy front and back uploaded to computer)
If you require assistance with completion of this form or if you have any questions, please contact the Office of Health Services at (334) 833-4440.
