Required Health Forms
These forms are due 2 weeks prior to your arrival on campus.
Required Health & Immunization Forms
If you will be under age 18 when you arrive on campus you and your parent or legal guardian must complete the Consent to Treat Minor Patient form. Once completed please upload the form directly to the Student Health Services portal.
MCLA Health and Immunization Forms: Visit the Student Health Services portal to complete the required Health and Immunization forms. Please upload a copy of your most recent primary care provider health/physical exam and your most recent immunization records.
MCLA policy and Massachusetts Immunization Laws 105 CMR 220.00 and 105 CMR 220.600 require all full-time undergraduate and graduate students under 30 years of age* to submit immunization records. While these are the minimum requirements, we recommend all students be immunized to prevent outbreaks. Failure to submit proof of immunizations will result in an academic hold.
Students who must be in compliance with our immunization requirements include:
- *All residential students are required to satisfy all screening and immunization requirements
regardless of age or credits prior to moving onto campus for summer, fall or spring semesters. - Undergraduate commuter students who are taking 9 or more credits and are under age 30.
- Graduate students taking 9 or more credits and are under age 30. This includes students
who may
alternate between part time to full time status for an individual semester. - Students in any Health Science program including Radiologic Technology and Nursing,
regardless
of age or credits. - Students attending MCLA from international locations regardless of age or credits.
This includes
students attending through any visa, including Visiting Scholars and foreign exchange students.
The following documentation of immunizations with appropriate dates are required by the Commonwealth of Massachusetts:
- 2 doses of measles, mumps, and rubella (MMR) or laboratory evidence of immunity.
- 2 doses of varicella vaccine or laboratory evidence of immunity or documentation by a health provider stating that the student has a reliable history of chickenpox with the month and year documented.
- 1 dose of Tetanus, diphtheria, pertussis-Tdap within 10 years.
- 3 doses of Hepatitis B vaccine or laboratory evidence of immunity.
- 1 dose of meningitis ACWY (formerly MCV4) vaccine for students 21 years of age or younger. The dose must have been received on or after the student’s 16th birthday. The Law provides exemption for meningococcal vaccine only for students signing a waiver that can be reviewed and downloaded from the Health Services web page.
- T-spot or IGRA test - required for international students only
MCLA Health Information Use and Disclosure Form
This release form will allow Health Services the ability to access your Berkshire Health Systems hospital records should you require emergency care from the local hospital, or any testing ordered from health services. This release complies with HIPPA guidelines, while allowing us to provide you with a continuum of care and assist you in any follow-up care required. Please note this information will be maintained in the strictest confidence and will only be used as needed for the continuation of your care.
MCLA TB Risk Assessment Form
All students must complete the TB Risk Assessment form. For students joining us from
international regions, note that you must have TB testing. Either T-Spot or IGRA (Tuberculin)
testing is accepted. This testing must be completed within 3 months of your travel to MCLA. Please include those results with your immunization record.
