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Health Form and Requirements

Congratulations on your acceptance to UMass Dartmouth. To comply with our health requirements, you must:

  • Complete and submit the tuberculosis questionnaire.
  • Submit your immunization record (required by Massachusetts Law).
  • Fill out a waiver if you’re not going to receive the meningitis vaccine.

Thank you for your early attention to these requirements.

Download the health form and waiver

Download a printable version of the 2014-2015 Health Form

Download a printable version of the Meningitis Waiver Form

Filling out the health form

We’ve included the following steps to help you complete the health form:

1. Be sure to answer the tuberculosis (TB) questions on page 4. Note: If you answer YES to any of the questions, you must then have your healthcare provider fill in the TB section on page 2. If your TB information is not documented, your Health Form will be considered incomplete.

2. Have your health care provider fill out and sign the immunization information page 2, or attach a copy of your immunization record that is available from your high school or previous college. Please send copies only, as we will destroy the originals once the dates are entered into our database.  

3. All full-time and part-time new residential students must read the information about bacterial meningitis. If you decide that you want the vaccine, your health care provider must fill in the date you received the vaccine on page 2 of the Health Form and sign the form or submit proof of this vaccine on a form from your healthcare provider.

If you are unsure, or if your meningitis vaccine will be delayed beyond the due date, please sign the waiver on the bottom of the Meningitis Waiver Form.

You can always submit the meningitis vaccine information later. Massachusetts law requires that we have this information on file in order for you to live on campus.

4. Mail the completed health form to:

University of Massachusetts Dartmouth
Health Services
285 Old Westport Road
North Dartmouth, MA 02747

Due dates

These requirements are due by June 1 for fall acceptance, January 15 for spring acceptance, or 30 days after acceptance. Failure to comply will adversely affect your admission or result in a hold on your registration, and residential students will not be allowed into the residence halls.

Physicals

The Health Services office does not require physicals.

However, students participating in Intercollegiate Athletics will need a physical. The form is available from the Athletic Department. Do not send the athletic physical form to Health Services; please send it directly to the Athletics Department.

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