Student Health Forms and Resources
Forms Required for Registration:
Tuberculosis Screening Questionnaire
Release of Information Form
This is not a mandatory form. Just complete if you need one of the following:
- You seek care at Curry Health Center and need previous health records sent to Curry Health Center.
- You want Curry Health Center to send your health records to another location.
Authorization for Release of Health Information
Authorization for Release of Health Information - ATC ONLY
Change Student Health Insurance Selection
Before the 15th Class Day
All changes to insurance selections are now done through an electronic form located here:
Please request all changes via this electronic form.
Distance Only Students:
If you would like to enroll in the Student Health Insurance Plan (SHIP), please fill out the form above to opt in. If you want to use services at Curry Health Center, you must also opt in to the Health Services Fee as part of your tuition. If you choose not to opt in to the Health Services Fee, you can still enroll in SHIP and use the insurance at clinics in the community.
After the 15th Class Day
Changes are only allowed in special situations and they require documentation and review.
- To request a late change, complete the
Both forms are processed within 3-5 business days.
Class Excuse Form
Please use the following form if your instructor requires an excuse from class and you've had a minor resolved illness that does not need medical evaluation.
Request for Vaccine Accommodation
Religious: If you are requesting a religious accommodation to the vaccine policy, please complete the following form and return to Curry Health Center staff:
Please return the completed form to the Medical Reception Desk at Curry Health Center. This form also must be resubmitted annually for your accommodation to remain in effect. Please make sure to accomplish this well in advance of registration to avoid having a registration hold impact your ability to register on time. The laws governing this process can be reviewed .
Medical: If you are requesting a medical accommodation to our immunization policy OR that of a partner organization (i.e., clinical rotation site), an attestation from your doctor will be required. The following must all be addressed:
(i) attest that the physical condition of the person enrolled or seeking to enroll in school or the medical circumstances relating to the person indicate that some or all of the required immunizations are not considered safe; and
(ii) indicate the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization.
(b) The person is exempt from the requirements of this part to the extent indicated by the medical exemption statement.
(c) The medical exemption statement must be signed by a person who:
(i) is licensed, certified, or otherwise authorized by the laws of any state or Canada to provide health care as defined in ;
(ii) is authorized within the person's scope of practice to administer the immunizations to which the exemption applies; and
(iii) has previously provided health care to the person seeking the exemption or has administered an immunization to which the person seeking an exemption has had an adverse reaction.
Please deliver the necessary attestation to the Medical Reception Desk at Curry Health Center.