Required Medical Forms

  • US Citizens

    All full-time and part-time undergraduate students are required to complete the online Required Medical Forms.
    You will receive a packet of information in the mail about completing this requirement. 
    A physical is not required.

    THE FORMS MUST BE COMPLETED WHETHER:
    You do or DO NOT plan to use healthcare services on campus
    You live on or off campus

    THE FORMS MUST BE COMPLETED IN ORDER TO :
    Select classes for future semesters
    Access healthcare in clinical services
    Receive access to your on-campus housing

                                                                *****IMPORTANT*****

    Students who will be living on campus must complete the online Options for Meningitis Compliance form prior to move-in day. Students are required to enter the date they received a meningitis vaccine that covers meningococcal A,C,Y, and W-135 or the waiver option - students must be 16 years or older when they received the vaccine. See the online form for details.

    NOTE: MINORS (students under 18 years old at the time the form is completed) who are not vaccinated for religious or other reasons must have a parent or guardian complete and submit the following form:

    MENINGITIS WAIVER FOR A MINOR

    To access the online forms click on the Required Medical Forms button at the bottom of this page. Log in with the username and password you received from the Admissions Office.

    NOTE: You will have access to the online forms after you receive the packet of information in the mail.

    Complete this requirement prior to your arrival on campus or the start of the semester, whichever occurs first.

    Failure to do so will result in your inability to register for future classes. 

  • Graduate, Certification, Professional Credit, Lifelong Learning, and Online Program Students

    IF YOU DO NOT PLAN TO UTILIZE CLINICAL SERVICES OR LIVE ON CAMPUS YOU ARE NOT REQUIRED TO COMPLETE ANY FORMS FOR THE HEALTH AND WELLNESS CENTER

    If you will be residing on campus you must complete the following:

    • Options for Meningitis Compliance Form online.

    If you plan to access healthcare through Clinical Services, you must do the following:

    • Pay the per semester health center fee that will be placed on your KU account when you are seen for your first appointment.
    • Complete all of the online Required Medical Forms.

    To access the online forms click on the Required Medical Forms button at the bottom of this page.

  • International Students - Undergrad

    All international students attending Kutztown University must complete 
    the Health and Wellness Center requirements by following the 2 steps listed below:

    1. SUBMIT THE FOLLOWING INFORMATION BY MAIL OR EMAIL:

                                        Immunization Records
    You must submit documentation for the following required immunizations:

    • Tetanus in the last 10 years
    • 2-MMR Vaccines
         1st dose - 12 months or older
         2nd dose - at least 28 days after 1st dose
      NOTE-proof of immunity by blood test for Measles, Mumps and Rubella is acceptable

                            Confirmation of Health Insurance Form
    You will receive an email with this form attached. 
    DO NOT complete this form online. 
    You must mail or email the paper form.
    All international students are required to maintain health insurance while attending Kutztown University.

                                     TB Screening Questionnaire
    You will receive an email with this form attached. 
    If you answer "YES" to any of the questions on PART 1 of the online form you must have your physician complete PARTS 2 and 3 of the paper form.

    Email - Lois Piehel or m
    ail - Health & Wellness Center, PO Box 730, Kutztown, PA 19530

    STEP 2 - COMPLETE THE ONLINE REQUIRED MEDICAL FORMS

    TO ACCESS THE ONLINE FORMS:

    Select the "REQUIRED MEDICAL FORMS" button at the bottom of this page.

    You will need to enter your university network username (your KU email address up to but not including the @ sign), password and date of birth.

    Complete all of the requirements prior to your arrival in the U.S.

    Failure to do so will result in your inability to register for future class

  • International Students - Grad

    All graduate international students must compete the following Health and Wellness Center requirements:

    SUBMIT THE FOLLOWING INFORMATION BY MAIL OR EMAIL:

                            CONFIRMATION OF HEALTH INSURANCE FORM
    You will receive an email with this form attached. 
    DO NOT complete this form online.
    You must mail or email the paper form.
    All international students are required to maintain health insurance while attending Kutztown University.

                                      TB SCREENING QUESTIONNAIRE
    You will receive an email with this form attached.
    DO NOT complete this form online.
    You must mail or email the paper form.

                                   **********IMPORTANT**********

    If you plan to live on campus or access health care through clinical services you must also do the following:

    • MAIL OR EMAIL YOUR IMMUNIZATION RECORDS   

      You must submit documentation for the following required vaccines:
    •    Tetanus Vaccine in the last 10 years
      • 2 - MMR Vaccines
                       1st dose - 12 months or older
                       2nd dose - at least 28 days after 1st dose
                  NOTE - proof of immunity by blood test for Measles, Mumps and Rubella is acceptable
        
    • COMPLETE THE ONLINE REQUIRED MEDICAL FORMS

    NOTE - If you choose to access health care in Clinical Services the per semester health center fee will be placed on your KU account when you are seen for your first appointment.

    Click on the "REQUIRED MEDICAL FORMS " button at the bottom of this page to access the online Required Medical Forms.

    Login with your university network username (the beginning of your KU email address up to, but not including the @ sign), password and date of birth. 

    FAILURE TO COMPLETE THESE REQUIREMENTS WILL RESULT IN YOUR INABILITY TO REGISTER FOR FUTURE CLASSES.

    Email - Lois Piehel or Mail - Health and Wellness Services, PO Box 730, Kutztown, PA 19530