A completed health history form is required by RWC and is sent to each new student prior to arrival on campus by Admissions. All information is kept in confidential files located in the Health Center.
To download this four-page form, please see the links shown below. Send completed forms to the Health Center either by fax or through the mail.
TRADITIONAL UNDERGRADUATE HEALTH FORM:
To be completed by student, parent(s), and medical provider.
Health History Form
*An up-to-date immunization record from a previous school or doctor may be submitted to fulfill the requirements of page 4.
**If the meningococcal meningitis vaccine is declined (see page 2 of the health history form), the appropriate line must be signed and dated by the student.
Immunization requirements are the same for all our students taking six or more credits per semester regardless of type of student. Part-time, non-traditional, and graduate students, however, do not submit proof of a physical or complete a health history record. Each program or division will mail the appropriate immunization form to the prospective student at the time of acceptance into the program. A generic immunization form may be downloaded by clicking here.
Measles, Mumps, Rubella (MMR)
All college students born after 1956 need two doses of MMR given at least 28 days apart. The first dose is usually administered after the first birth date, and the second dose is generally given between the ages of four to six. Serologic evidence of immunity (positive titer tests for measles, mumps, and rubella) is acceptable as long as a copy of the lab results is submitted to the Health Center.
Proof in the form of an official copy of immunization dates from a doctor or previous school must be on file in the Health Center within 30 days of the start of the first class. (See page 4 of the health history form.)
Exceptions
A student may be exempt from either or all of the required immunizations for medical or religious reasons. Certified documentation must be submitted to the Health Center.
• Students who were born prior to January 1, 1957, are exempt from the MMR requirement.
• The law does not apply to students enrolled for fewer than six semester hours.
• Proof of honorable discharge from the armed services within ten years from the date of application to RWC qualifies as a certificate enabling a student to attend classes pending actual receipt of immunization records from the armed services.
Tuberculosis Screening (TB)
This is not a vaccine. Proof of a TB test is needed for all traditional undergraduates within the past 12 months, and only PPD (Mantoux) tests are acceptable. Both the placement date and the read date (which must be within two to three days) must be indicated. A positive TB test will require a chest x-ray and evaluation for medication. Additionally, nursing majors are required to get annual PPD tests.
Meningococcal Meningitis Vaccine
NYS requires all colleges to distribute information regarding meningococcal meningitis disease along with vaccination information, which is included with the health history form or may be downloaded by clicking here.
Although this vaccine is not required for college attendance in NYS, it is highly recommended. The Health Center offers the meningococcal vaccine on campus with advance payment. Please call 585-594-6360 or email Burks_Blandine@roberts.edu to obtain current price, make payment arrangements, and schedule an appointment.
NOTE: If the meningococcal meningitis vaccine is declined (see page 2 of the health history form), the appropriate line must be signed and dated by the student.
Tetanus/Diphtheria Booster
Most recent Td booster must be within past 10 years.
Hepatitis B
Students enrolled in the Nursing program are required to provide evidence of Hepatitis B immunity.
