Student Health Form NCAA Athlete Health Form
U.S./Domestic Student Health Form (PDF) U.S./Domestic NCAA Athlete Health Form (PDF)
International Student Health Form (PDF) International NCAA Athlete Health Form (PDF)
Health Form Deadline: NCAA Athlete Health Form Deadline:
Fall Semester – July 1
Spring Semester – December 1
(Student accepted after the deadline have
30 days from date of acceptance to
complete health form)
June 1 – Basketball & Summer School Enrollees
July 1 – All Sports Fall Enrollees

 

RETURNING STUDENT ATHLETE FORMS

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

 

Submit completed forms to:

Valparaiso University Student Health Center
55 University Drive, Suite 102
Valparaiso, IN 46383

OR
Fax: 219.464.5410

 

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 (Indiana Code 21-40-5).

 

Valparaiso University requires all full-time undergraduates, graduates, and all international students to complete the Health Form. You will find links for the form above. The Health Form must be completed by July 1 for fall semester enrolled students and December 1 for spring semester. Any student who has not submitted the Health Form will have a hold placed on their student account. The hold will prevent the student from accessing grades and registering for classes the next semester.

 

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 two Meningococcal Quad (MPSV4 or ACWY), two MMR (measles, mumps, and rubella) and a current Tdap/Td (tetanus, diphtheria). Tuberculosis testing is required of all International students and any domestic student who has lived or had extensive travel to high-prevalence regions, including Africa, Asia, Philippines, Indonesia, Eastern Europe, Latin America, Mexico, Portugal, the Caribbean, and the Middle East.

Meningococcal Quad (MPSV4 or ACWY) – The first MenACWY is given at age 16 years of age. The second MenACWY must be given at least two months after the first dose.

MMR (measles, mumps, and rubella) – 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.

Tdap/Td (tetanus, diphtheria) – The Tdap or Td must be given within the last 10 years. The Tdap (tetanus, diphtheria, and 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 (PDF) – currently being updated

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