Health Services

Health Forms

Undergraduate Student Forms | Graduate Student Forms

Clark University Health Services
950 Main Street
Worcester, MA 01610
Telephone: 508–793–7467
Fax: 508–751–5947

Undergraduate Students (new incoming students only)

Please download, complete, and return your required health forms to the address below by July 1 for the fall semester and January 2 for the spring semester. Please note that all forms are PDFs.

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

1 Undergraduate Immunization 2018
2 Undergrad Tuberculosis_Screening_Questionnaire
3 Clark University Health Services Tuberculosis Screening-Testing-Management
4 Clark University Health Services PHYSICAL EXAMINATION FORM
5 meningococcal-info-waiver
6 Consent to Treat Minor

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

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 the Health Service if you have not returned your forms by the deadline.

 


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 the following Graduate Immunization Record forms:

1 Graduate Immunization 2018
2 Graduate Tuberculosis_Screening_Questionnaire
3 Clark University Health Services Tuberculosis Screening-Testing-Management
4 meningococcal-info-waiver


Accelerated Degree Program Students — Undergraduates students who enter a master's degree program after earning their B.A. as part of the Accelerated Degree Program must submit a new TB Risk Questionnaire and a Meningococcal waiver. Immunization files will be reviewed by the Health Services and students will be notified by e-mail if additional immunizations are needed.

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 January 2nd 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.