Valparaiso University Health Requirements

Student Health Forms

NCAA Athlete Health Form

U.S./Domestic student Health Form

 

International student Health Form

U.S./Domestic NCAA Athlete Health Form

 

International NCAA Athlete Health Form

All late or incomplete forms will result in a $50.00 fine.

If you want to submit the form electronically (email) you will need to print the form and scan it back to your computer. 

Due Date:

NCAA Athlete Due Date:

Due before the first day of class

June 1st -Basketball & Summer School Enrollees

July 1st- ALL Sports Fall Enrollees

All forms must include supporting documents or a provider's signature for proof of immunizations.

Submit completed forms to:  Valparaiso University Health Center, 55 University Drive, Suite 102, Valparaiso, IN 46383   Fax: 219-464-5410 or Email:health.center@valpo.edu

It is the law that young adults attending post-secondary schools in the State of Indiana be immunized against or show proof of immunity to certain vaccine preventable and communicable diseases (IC 20-12-71). Valparaiso University requires all full-time undergraduates and full-time law students and ALL international students to complete the Health Form. You will find links below for the Health Form. The Health Form must be completed by the first day of classes. If your completed Health Form is not submitted by the first day of classes you will be assessed a $50.00 fine. Students who do not turn in the completed Health Form within two weeks after classes begin will additionally have a hold placed on their academic account. The hold will prevent the student from accessing grades and registering for classes.

All Health Forms must be in English. All forms must include supporting documents or a provider's signature for proof of immunizations. All students must provide proof of 2 MMR (measles, mumps and rubella) and a current TD (tetanus, diphtheria). Tuberculosis testing is required of all International students and any domestic student who has lived or had extensive travel to a high prevalence country, including Africa, Asia, Philippines, Indonesia, Eastern Europe, Latin America, Mexico, Portugal, Caribbean and the Middle East.

MMR - The first MMR must be given after 12 months of age. The second MMR must be given at least one month after the first dose.

TD - The TD must be given within the last 10 years. The TDap (tetanus, diphtheria, pertussis) vaccination is preferred.

Click here for Valparaiso University immunization policy and the necessary forms to apply for immunization exemption. If you file an exemption you will still need to complete the Health Form above.: Immunization Exempt Forms