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Health Center Forms

To promote a healthy living environment on campus and to protect our campus community from vaccine preventable diseases, the University requires all students to have a physical exam and updated immunizations prior to their arrival on campus. Also, in the event of an emergency, it is important for us to have emergency contact phone numbers on file, as well as other important information about students such as their health histories, medical conditions, allergies and medications. We suggest you contact your health care provider soon to schedule a time for a physical and to receive any immunizations you might need.

Sources of information to complete the immunization page include: your health care provider, your high school, your local health department and your “baby shot record book.” Make copies of the forms for your records before you mail them since students often need copies of the information in the future for employment or graduate school.

Bring your completed forms with you when you attend your Preview session and give them to a nurse at the Resource Fair or place them in the box at the Information Desk. If you do not attend Preview, or if you cannot complete your records before your Preview session, mail them a month prior to your arrival on campus to: Health Center, University of Mount Union, 1972 Clark Ave. Alliance, Ohio 44601. Do not enclose them with other forms you mail to the University.


  1. Completion of all seven pages of the health forms.
  2. Physical exam (including athletes). Part of the physical exam includes questions about tuberculosis screening and possible testing.
  3. Tetanus-Diphtheria booster (or Tdap) in the past 10 years.
  4. MMR (Mumps, Measles, Rubella) two doses.
  5. Signature on the Meningitis and Hepatitis B vaccine Status Form. (Required for on campus housing).

All immunizations are recommended to be up to date (when appropriate) to prevent illness and the spread of all vaccine preventable diseases. Discuss with your health care provider which vaccines he/she recommends for you. Refer to the following web pages for more information about immunizations: or