Prospective Full-time Student Health Service Requirements

Upon acceptance to Lincoln College ALL full-time students are REQUIRED to complete health records.  Health records are REQUIRED to be complete PRIOR to or on the day of move-in.  Late fees will be enforced if after that time.  $15 if not completed by move-in day.  After 2 weeks an additional $10 will be added.  If records are not complete by mid-term the student could be dismissed from school.

Please use the following instructions to assist in completing the records.  All forms mentioned below are available on Lincoln College website: http://www.lincolncollege.edu/student_services/nursing.htm

1. Lincoln College Health History Form
• This form is REQUIRED
• Complete ALL sections of this form The signature of the student is REQUIRED in
   Section C.
2. Lincoln College Immunization Form
• This form is REQUIRED
• Complete the top section of this form and “statement by the student” which requires the signature of the student.

Section A—Required Immunization information.  This requirement may be met in one of the following ways.  A complete immunization (shot) record from high school, former college, physician’s office, health department or a copy of official military records.

Students born BEFORE January 1, 1957 or with Medical or Religious exemption please contact Health Services for information on required immunizations.

• refer to Immunization and Physical Exam information sheet (web info) for further details regarding the requirements.

Section B—Tuberculosis information.  This section is required IF student is international OR if student answered YES to any of the questions on the Tuberculosis Risk Questionnaire. 

Section C—Recommended immunization information.  Those immunizations are not required for attendance at Lincoln College.

Only needs to be signed by physician or public health official if they are completing the form.

3. Lincoln College Tuberculosis Risk Questionnaire
• This form is REQUIRED
• complete the information at the top, answer ALL questions and signature of student is REQUIRED at the bottom of the page.
4. Release of Information
• This form is REQUIRED
• once completed by the student, Health Services can submit the form to your previous school to obtain a copy of the immunization (shot) record if available.
• Use this form when requesting records to be sent TO Lincoln College.
5. Student and Parent / Guardian Information Form.
• This form is REQUIRED
• complete the personal information section and answer question if insurance, public aid or none.
• the parent information MUST be completed by ALL.
• the student information section ONLY needs completed if the student has their own policy.
• student AND parent MUST sign the Authorization section.
6. Health Information Request Form
• Use this form when requesting immunization or physical to be sent to another school.
7. Lincoln College Physical Form
• students who participate in competitive sports (excluding intramural sports), cheerleading, and dance team at Lincoln College MUST have a physical examination, completed by a physician EACH year and PRIOR to the beginning of the sport/activity—including any try outs.

 

 

Updated 5/16/11

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