Forms for new and transfer students entering Fall 2022:
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 15, 2022.
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 be 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 FormNew Student Health Form (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.
- Students needing to complete the State of Connecticut Religious Exemption Form may find it here. The Connecticut Department of Public Health Medical Exemption Certification Statement 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 1, 2022.
If your physical is not dated within 1-2 years of July 2022 and is not scheduled until after July 1, 2022, please be sure to submit the completed forms and then submit your physical once it is complete.
Contact Student Health Services, 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