Forms for new and transfer students entering Fall 2023:
Student Health Insurance
- Please be sure to review the Student Health Insurance Plan and, if you have comparable private insurance, waive out at www.gallagherstudent.com/conncoll. You must also email a copy of your private insurance card, front and back, to Student Health Services at SHS@conncoll.edu. Please note: all new/transfer students must either waive out or enroll in, the College-sponsored plan by August 16, 2023.
Health Consent and Student Health History Form and New Student Health Form
Connecticut state law and Connecticut College policy mandate that a completed health form is on file in order for students to attend classes. The information provided will be kept confidential.
- Complete your Connecticut College Health Consent and Student Health History Form by visiting the Student Health Services Web Portal. Click on the link that says, “You have pending forms", complete the document, and submit.
- All new students must download and print the New Student Health Form rev. 04/21/23 (a combined 5-page document) that needs to be submitted to Student Health Services. It consists of the Certificate of Immunization, Tuberculosis Screening Form, Tuberculosis Testing Form, Physical Exam Form, and Consent to Treat Minor form.
- In accordance with the state of Connecticut law, the students that are eligible to seek a religious exemption are those who have a previously documented religious exemption for required immunizations. This exemption must have been in effect on or before 4/28/2021. Students that hold this Religious Exemption must submit a stamped notarized copy to Student Health Services. A student who has not received a documented religious exemption on or before 4/28/2021 are not eligible to seek a religious exemption for required immunizations.
- The State of Connecticut Medical Exemption form may be found here.
Students should enter their vaccination dates from the Certificate of Immunization Form by following these steps:
The due date for completion of these forms is July 15, 2023.
If your physical is not dated within 1-2 years of August 2023 and is not scheduled until after August 21, 2023, please be sure to submit the completed forms and then submit your physical once it is complete.
Contact Student Health Services, at (860) 439-2275 (please leave a message), or email firstname.lastname@example.org, if you have questions or are unable to complete part of this form.
Please note that Connecticut state law requires that all full-time or matriculating students, born after December 31, 1956, who are attending higher education programs in Connecticut, must provide proof of adequate immunization against measles, mumps, rubella, and varicella. Additionally, state law requires that students who reside in on-campus housing be vaccinated against meningitis and submit evidence of having received a meningococcal conjugate vaccine not more than five years before enrollment as a condition of such residence. A copy of the statute is available at https://www.cga.ct.gov/current/pub/chap_185b.htm#sec_10a-155.
The College, following recommendations from the Connecticut Department of Health, requires Tuberculosis screening for all new students, both domestic and international. Connecticut College is also required by CT statute to provide information regarding meningitis and Hepatitis B infections and the benefits of vaccination.
Hepatitis B: http://www.immunize.org/catg.d/p4205.pdf
Student Health Services at Connecticut College provides allergy shots that are followed by a community allergist from their hometown. This allows the student to continue to benefit from the care of their hometown physician while avoiding the time and expense of going home for each injection. Advanced Practice Providers staff Student Health Services. There is not a physician present. At any given time, we have patients cared for by many different allergists, each with their own order forms and labeling practices. The guidelines presented in our Allergy Packet were written with patient safety as the highest priority.