Health History Form and Immunization
An Important Message from A. H. Ray Student Health Services
All students are required to meet the University's enrollment requirements. The Health History form and Immunization records are an important part of the enrollment process. Please do not wait until you arrive on campus to attempt to submit documents or complete requirements. Your enrollment will be interrupted without proper documentation.
- The Health History form is a required document for all students taking one or more classes with the exception of students enrolled in off-campus Distance and Web based curriculums. The Health History form is an important tool for you, the University's Health Care Providers and Health Center Nurses in understanding your health history and needs. This form may be accessed and downloaded from the Health Services website. The instructions for completion are listed above each section.
Please note that the School of Health Sciences, Departments of Education and Athletics may additionally require copies of a completed Health History form and Immunization record. If this is the case, the student is responsible for supplying a copy of the documents to the aforementioned departments and is still required to submit the completed original Health History form and Immunization record directly to the Student Health Service by mailing to the address on the Health History form.
- The Immunization requirements for the State of North Carolina
- N.C. G.S. 130A-155.1 requires persons attending a college or university, whether public, private or religious, to present a Certificate of Immunization or a record of immunization from a high school located in North Carolina. For out-of-state students, a Certificate of Immunization or high school immunization record indicating that the person has received immunizations is required to attend a college or university in North Carolina. Criteria can be reviewed by visiting http://www.immunizenc.com/college.htm.
N.C. G.S. 130A-156 and 157 (2002)
Medical Exemptions: Requests for exemption from required immunizations for medical reasons require the submission of a written and signed statement from a physician licensed to practice medicine in the State of NC stating that a required immunization may be detrimental to said person's health due to one or more of the contraindications adopted by the Commission.
Religious Exemptions: For bona fide religious beliefs and opposition to the immunization requirements, a written and signed statement from the adult student or parent/guardian is required. Student Health Services must received a signed statement from the spiritual leader printed with the religious affiliation letterhead. There is no exception to these requirements for the case of a personal belief or philosophy of a parent or guardian not founded upon a religious belief. Health Services request that statements of exemption be submitted at least 30 days prior to the student's arrival on campus.
Upon the Student Health Center's receipt of the signed statement, the person may attend the university. The exemption message continues.
Others exempted from the immunization requirements include part-time students taking classes after 4 p.m., Saturday classes only, and students enrolled in Distance and Web based programs not held on campus. See the following important notices.
- It is the student's responsibility to submit the required immunization information to Student Health Services should their status change from part-time to full-time or the student's class hours change to include any class taken prior to 4 p.m. Monday through Friday.
- Transfer students, based on enrollment status, are also required to submit the required Health History and Immunization records directly to Student Health Services prior to enrollment.
- Failure to comply with the immunization statute will result in blocks and disenrollment from the University. If you have any questions or concerns, please contact the Student Health Center at (336) 750-3300.
The Health Center Staff Welcomes You!