Student Health Forms

Student Health Forms


Student Health Form

All Students

Please read the meningitis information on page two of the health form! For our records, all students must decide whether or not they want to receive the vaccine. If you decide no, you must sign the waiver found at the bottom of page two.

All new students with nine or more credits taken on campus must complete a Student Health Form as part of their admission requirements on or before these dates:

  • April 1 for Summer Admission
  • July 1 for Fall Admission
  • Dec. 1 for Spring Admission

Student Health Form: download and print.

Completed health form may be ...

Faxed to 570-389-3417 or

Mailed to:

    BU Student Health Center
    324 Kehr Union Building
    400 E. 2nd St.
    Bloomsburg, PA 17815

Places to find your immunizations records

  • Baby Book
  • Family Doctor
  • High School
  • Military

If unable to find immunization records?

  • Vaccines may be given by your doctor or blood titers obtained. Only positive titers will be accepted.
  • Vaccines may be given by The Student Health Center for a fee.

Incomplete health forms result in ...

    A HOLD on your school record, which will not be released until the requirements are met. Students will be notified by mail or e-mail, if incomplete.

International Students

Health Forms:

  • Must be completed in English
  • If the vaccine or the tuberculin skin test (TST)requirements are not met, the student will be vaccinated and skin tested at the student's expense before classes begin. A TST must be done within 6 months of matriculation.
  • Payment is expected at the time of service

Health Insurance: