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Clark University
Office of
Health Services

Health Forms

What You Need to Know

Please keep a copy of all of your forms for your records. Please do not email health forms to Health Services.

You will be notified via Clark email only if your health forms are incomplete. You are responsible for checking your Clark email regarding your forms compliance.

Please do not call Health Services if you have not returned your forms by the deadline.

Immunization Before Attending Clark

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.

Mailing or Faxing Your Forms

Please mail or fax your forms to:

Clark University Health Services
950 Main St.
Worcester, Mass. 01610
Telephone: 1-508–793–7467
Fax: 1-508–751–5947

Undergraduate Students (new incoming students only)

Make an appointment with your health care provider to have your physical completed. We will accept physicals within the past two years.

Physical Examination Form

This form must be reviewed and signed by your health care provider. You must attach the completed form with your health forms packet. If risk factor(s) are present, please complete the required testing on the immunization record.

Tuberculosis Risk Assessment Form

You should 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 Health Services for those immunizations you may not have completed or that are not available in your country. Please note there is a charge for immunizations.

Undergraduate Immunization Form

Information about meningococcal disease, meningococcal vaccines, vaccination requirements, and the waiver for students at colleges and residential schools (Sept 2020).

Meningococcal Info Waiver

Complete only if your child is under 18 years old.

Director of Health Services
Clark University
950 Main Street
Worcester, MA 01610–1477

Consent to Treat Minor Form

Graduate Students (new incoming students only)

The State of Massachusetts requires that all students at any college within the state show a complete record of immunity against communicable disease. To ensure the best health for you and all Clark students, you will need to have your doctor or other health care provider complete Graduate Immunization Record forms.

This form must be reviewed and signed by your health care provider. You must attach the completed form with your health forms packet. If risk factor(s) are present, please complete the required testing on the immunization record.

Tuberculosis Risk Assessment Form

You should 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 Health Services for those immunizations you may not have completed or that are not available in your country. Please note there is a charge for immunizations.

Graduate Immunization Form

Information about meningococcal disease, meningococcal vaccines, vaccination requirements, and the waiver for students at colleges and residential schools (Sept 2020).

Complete only if age 21 years of age or under and did not receive meningococcal vaccine ACWY.

Meningococcal Info Waiver

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.

Please complete this form only if you have traveled outside the US and stayed longer than one month in the last 6 months.  If  NO to the first 3 boxes then check off the last box no TB risk factors and submit to health services.  If yes to any of the first 3 boxes you will be contacted by health services for testing.  This form does not have to be signed by a healthcare provider.

Tuberculosis Risk Assessment Form

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.

Meningococcal Info Waiver

All Graduate Students

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. Please contact Health Services at healthservices@clarku.edu if you have questions.

Students must complete and upload the Graduate Immunization Record, TB Risk Questionnaire and Meningococcal Form. Completed forms should be uploaded to your online account as “immunization form” in your Applicant Status Page. All forms must be submitted by July 1 for fall enrollment and Jan. 2 for spring enrollment.

Please make sure to keep the original copies of all your forms and bring them with you when you arrive to Clark for orientation.

You will be notified via Clark email only if health forms are not complete. You are responsible for checking your Clark email regarding your forms compliance.

Contact Information

Health Services

Office Location
Office Hours
  • Health Services is open Monday through Friday, 9 a.m. to 5 p.m.
    Health Services is closed when the University is closed.
  • Directions:
    Health Services can be reached either from Park Avenue or Birch Street. To get to Birch, take Maywood Street (heading toward Park Avenue) and then turn right onto Birch Street. Follow the signs to the Health Services building.