{"id":11,"date":"2025-09-26T08:58:24","date_gmt":"2025-09-26T12:58:24","guid":{"rendered":"https:\/\/www.clarku.edu\/health-services\/?page_id=11"},"modified":"2026-03-10T15:31:40","modified_gmt":"2026-03-10T19:31:40","slug":"health-forms","status":"publish","type":"page","link":"https:\/\/www.clarku.edu\/health-services\/health-forms\/","title":{"rendered":"Health Forms"},"content":{"rendered":"\n
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Undergraduate students (new incoming students only)<\/h2>\n\n\n\n

Students should make an appointment with their healthcare provider to complete the required health forms as soon as possible.  Forms are due 6\/22\/26 for fall admission.<\/p>\n\n\n\n

Please keep a copy of all of your forms for your records.<\/p>\n\n\n\n

Upload health forms using Clark credentials<\/strong><\/a><\/p>\n\n\n\n

Physical examination form<\/summary>\n

Make an appointment with your health care provider to have your physical completed. We will accept physicals within the past two years.<\/p>\n\n\n\n

Download Physical Exam Form<\/a><\/strong><\/p>\n<\/details>\n\n\n\n

Undergraduate immunization<\/summary>\n

This form needs to be completed, signed and dated by your healthcare provider.  You should try to complete as many of your required vaccines as you can prior to your arrival. There will be immunization clinics scheduled when you arrive at Clark University  for those immunizations you may not have completed or that are not available in your country.<\/p>\n\n\n\n

Download Immunization Form<\/a><\/strong><\/p>\n<\/details>\n\n\n\n

Information about Meningococcal<\/summary>\n

Please complete the meningococcal form below only<\/strong> if you have not received the meningococcal vaccine which is required age 21 or younger.<\/p>\n\n\n\n

Download information<\/a><\/strong><\/p>\n<\/details>\n\n\n\n

Consent to treat minors<\/summary>\n

Complete only<\/strong> if your child is under 18 years old.<\/p>\n\n\n\n

Download consent form<\/a><\/strong><\/p>\n<\/details>\n\n\n\n

Pre-registration form<\/summary>\n

Complete with other health forms. This will be used for visits at health service.<\/p>\n\n\n\n

Download pre-registration form<\/strong><\/a><\/p>\n<\/details>\n\n\n\n

Graduate students (new incoming students only)<\/h2>\n\n\n\n

Students should make an appointment with their healthcare provider to complete the required health forms as soon as possible.  Forms are due 7\/20\/26 for fall admission.<\/p>\n\n\n\n

Please keep a copy of all of your forms for your records.<\/p>\n\n\n\n

Upload health forms using Clark credentials<\/strong><\/a><\/p>\n\n\n\n

Graduate immunization record<\/summary>\n

This form needs to be completed, signed and dated by your healthcare provider.  You should try to complete as many of your required vaccines as you can prior to your arrival. There will be immunization clinics scheduled when you arrive at Clark University  for those immunizations you may not have completed or that are not available in your country.<\/p>\n\n\n\n

Download Grad Immunization Form<\/a><\/strong><\/p>\n<\/details>\n\n\n\n

Information about Menigococcal<\/summary>\n

Complete only if age 21 years of age or under<\/strong> and did not receive meningococcal vaccine ACWY.<\/p>\n\n\n\n

Download information<\/strong><\/a><\/p>\n<\/details>\n\n\n\n

Accelerated degree program students<\/h2>\n\n\n\n

Undergraduates students who enter a master\u2019s degree program after earning their B.A. as part of Clark\u2019s Accelerated Degree Program must submit a new TB Risk Questionnaire and a meningococcal waiver. Immunization records on file will be reviewed by the Health Services and students will be notified by email if additional immunizations are needed.<\/p>\n\n\n\n

Upload health forms using Clark credentials<\/strong><\/a><\/p>\n\n\n\n

Meningococcal disease, vaccine, and waiver<\/summary>\n

This form must be completed if you are 21 years of age or younger<\/strong> and did not receive a meningitis vaccine at 16 years of age or older.<\/p>\n\n\n\n

Download waiver<\/a><\/strong><\/p>\n<\/details>\n<\/div>\n\n\n\n

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Immunization info<\/a><\/div>\n\n\n\n
buy or waive health insurance<\/a><\/div>\n<\/div>\n\n\n\n