Undergraduate Students (new incoming students only)
Students should make an appointment with their healthcare provider to complete the required health forms as soon as possible. Forms are due 6/28/24.
Please keep a copy of all of your forms for your records.
Upload health forms using Clark credentials
Clark University Health Services
950 Main St.
Worcester, Mass. 01610
Telephone: 1-508–793–7467
Fax: 1-508–751–5947
Physical Examination Form
Make an appointment with your health care provider to have your physical completed. We will accept physicals within the past two years.
Download form
Tuberculosis Risk Assessment
Please complete the top section of this form, sign and date it. If all answers are no, no further testing is required. If you answer YES to any of the questions, you are required to have your healthcare provider complete the bottom section of the form, sign and date it.
Download Screening Form
Undergraduate Immunization
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.
Download Immunization Form
Information about Meningococcal
Please complete the meningococcal form below only if you have not received the meningococcal vaccine which is required age 21 or younger.
Download information
Consent to Treat Minors
Complete only if your child is under 18 years old.
Download consent form
Graduate Students (new incoming students only)
Students should make an appointment with their healthcare provider to complete the required health forms as soon as possible. Forms are due 7/26/24.
Please keep a copy of all of your forms for your records.
Upload health forms using Clark credentials
Clark University Health Services
950 Main St.
Worcester, Mass. 01610
Telephone: 1-508–793–7467
Fax: 1-508–751–5947
Tuberculosis Risk Assessment
Please complete the top section of this form, sign and date it. If all answers are no, no further testing is required. If you answer YES to any of the questions, you are required to have your healthcare provider complete the bottom section of the form, sign and date it.
Download TB screening form
Graduate Immunization Record
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.
Download Grad Immunization Form
Information about Menigococcal
Complete only if age 21 years of age or under and did not receive meningococcal vaccine ACWY.
Download information
Accelerated Degree Program Students
Undergraduates students who enter a master’s degree program after earning their B.A. as part of Clark’s 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.
Upload health forms using Clark credentials
Tuberculosis Risk Assessment
Please complete the top section of this form, sign and date it. If all answers are no, no further testing is required. If you answer YES to any of the questions, you are required to have your healthcare provider complete the bottom section of the form, sign and date it.
Download TB Screening Form
Meningococcal Disease, Vaccine, and Waiver
This form must be completed if you are 21 years of age or younger and did not receive a meningitis vaccine at 16 years of age or older.
Download waiver
