Health Forms
Instructions for all students
Please download, complete and return your required health forms packet (see links below) by July 1 for the fall semester and prior to January 2 for the spring semester. Which packet you fill out depends on your year of study: undergraduate (first-year or transfer) or graduate student.
Health Services will accept physical examinations within the past two years. Students should make arrangements for any needed immunizations with medical practitioners in their home country or state to avoid charges for immunizations and registration holds after arriving at Clark.
Students who plan to participate in varsity sports are required to complete a separate Athletic Physical Form. Athletic physical examinations are only valid six months from the date of the exam. Please remember to bring both forms to your medical appointment.
Undergraduate students
First-year students and sophomore transfer students (Classes of 2015 and 2016) [PDF]
Must be completed by all incoming first-year students and sophomore transfer students. Please mail
your completed forms by July 1 for the fall semester and prior to
January 2 for the spring semester. The UMass Memorial Pre-Registration form must be completed by all undergraduate students. This information is required for our electronic medical record system.
Clark University Health Services
Attn: Director, Health Services
950 Main Street
Worcester, MA 01610
Junior and senior transfer students (Classes of 2013 and 1014) [PDF]
Must be completed by all incoming junior and senior transfer students. Health Services will accept
a copy of your physical examination and immunizations from your previous
institution. Please mail your completed forms by July 1 for the fall semester and prior to January 2 for the spring semester. The UMass Memorial Pre-Registration form must be completed by all undergraduate students. This information is needed for our electronic medical record system.
Clark University Health Services
Attn: Director, Health Services
950 Main Street
Worcester, MA 01610
Clark University athletic physical exam form [PDF]
Must be completed by all incoming undergraduate students who plan to participate in varsity
sports at Clark University. Please bring this form to your medical appointment with your required
undergraduate forms packet above. Please mail your completed form to:
Clark University Sports Medicine Office
950 Main Street
Worcester, MA 01610
Graduate students
Accelerated Degree
Program (ADP) students [PDF]
Please complete and return the TB Risk Questionnaire to Denise
Robertson in the Graduate School. ADP students' immunization files will be
reviewed by the Graduate School Office and will be notified by e-mail if additional
immunizations are needed.
All other graduate students [PDF]
All incoming graduate students must complete and return the Graduate Immunization Record,
TB Risk Questionnaire and Meningococcal Form to the following:
GSOM students in the following programs must return forms to Deanna Scaramangos, Graduate School of Management
- Master of Business Administration (MBA)
- Master of Science in Finance (MSF)
IDCE students in the following programs must return forms to Erika Paradis, IDCE
- Community Development & Planning (CDP)
- Environmental Science & Policy (ES&P)
- Geographic Information Science for Development & Environment (GISDE)
- International Development & Social Change (IDSC)
All other graduate students must return forms to their departments or to Denise Robertson in the Graduate School.
Please address envelopes as follows:
Name (See above)
Department
Clark University
950 Main Street
Worcester, MA 01610 USA