Form

HEALTH FORM/ IMMUNITY REQUIREMENT

The following is a checklist of health document requirements:

1) health history and physical examination form with the required immunity documented for measles, mumps, and rubella (MMR). Here is a helpful information sheet to assist you in filling out the health form.

AND

2) Acknowledgement of meningitis requirement Meningitis Information Acknowledgement Form

IMPORTANT

To comply with NEW YORK STATE PUBLIC HEALTH LAW ...

A student's enrollment, course registration, campus housing and financial aid at Binghamton University depend on compliance with the MMR and Meningitis requirements. Students must fulfill these requirements to be eligible to register for classes. If you are not officially registered for courses, your campus housing and eligibility for financial aid will be affected. You will not be able to remain in campus housing and we will not be able to process your financial aid nor generate refunds, if applicable, until these requirements are met.

Please take action on these requirements promptly!

Avoid the lines ... send in your forms before you arrive at Orientation.

These two(2) forms above require signatures and so must be mailed or faxed

You must have Adobe Acdobat Reader to view and print any of the forms linked to this page. If you need to install the reader follow this link and return

WHO?
The submission of a completed health history and physical examination form is required for all students. The physical examination portion is recommended for all students.

DO THIS: All students are required by Public Health Law to sign and return the Meningitis Information Acknowledgement Form. Receipt of this form by the University Health Service is critical to remaining eligible for course registration at Binghamton University.

WHAT?
For the Health Form, a physical examination is recommended and the Mandatory Tuberculosis Screening form and PPD Mantoux skin test (if indicated) is required (by September 26, 2008). The PPD must have been performed in the United States or Canada within the calendar year prior to admission to Binghamton. Tine skin tests are not valid. Transfer students may submit their health forms from their previous institutions for review by Binghamton Health Service staff. In this instance, the physical examination report will often suffice, but an updated tuberculin (PPD) skin test may be necessary. The University Health Service offers PPD skin tests at no charge.

Meningitis: Students must return a signed statement acknowledging receipt of information from the campus about meningococcal disease and the availability of vaccination. The statement also identifies the vaccination status of the student. The response form is mandated by law in New York State and is necessary to complete health requirements.
Please see links at the top of this page for meningitis information and the required acknowledgement form. The required response is also included on the health form itself for the convenience of entering students.

HOW?
The Health Service Vaccine Clinic offers PPD skin tests and MMR (Measles, Mumps, Rubella) vaccine at no charge. Physical exams must be done off campus, and a list of nearby offices is available where examinations may be performed.