Forms

• Traditional Undergraduate Students State and SEU Medical Requirements
• Minor Consent Form
• Authorization to Release Medical and Immunization Documents to SEU
• Authorization to Release Medical Information from SEU

Please download and print a copy of the University's and State of New Jersey's Medical Requirement form which includes the following items:

• Required Form A - Health Form
• Required Form B - Immunization Record
• Required Form C - Meningitis Information Sheet

Complete Forms A - C in its entirety and have your physician complete their portion.

• Fall semester deadline is June 1
• Spring semester deadline is November 15
• Summer programs EOF, Honors and Global Scholars participants must submit these forms prior to May 1.

Be aware other departments may require additional health requirements (Athletics, Physician Assistant, Foods and Nutrition, Education, Psychology and Nursing). Make sure you contact these departments for further information.

Send or fax your completed forms to:

SEU Health Services
Founders Hall
2 Convent Road
Morristown, NJ 07960

Fax: (973) 290-4182

University Health and Immunization Requirements

The following are the basic requirements for traditional undergraduate students. Please refer to the instruction portion of the forms for more detailed information.

• You are required to fill out the information data sheet.
• You and your physician are required to complete the Medical History and Physical Forms.
• You and your physician are required to complete the immunization form.
• The immunization requirements are as follows:
  • COVID 19 vaccine series and boosters
  • 2 measles vaccines
  • 2 mumps vaccines
  • 2 rubella vaccines
  • Meningitis vaccine (serogroup ACWY)
    • Students less than or equal to 23 years old and all resident students
    • Final dose must be administered at or after the age of 16 AND within 5 years of entry
    • Meningitis serogroup B vaccine – all students less than or equal to 23 years old and further recommendation as per the CDC
  • ALL must read the Meningitis Vaccine Information statement. You must also complete and sign the Meningitis Information Sheet and return it to Health Services.
  • 3 Hepatitis B vaccines (or 2 dose series – Heplisav)
  • Inteferon-gamma release assay test (IGRA) or PPD/Mantoux testing (within one year)
    • PPD/Mantoux
      • Plant date and the read date is required.
      • Reading needs to be in millimeters of induration.
    • IGRA – copy of lab request required
    • If you have a history of a positive PPD/Mantoux or IGRA, you need a chest x-ray (within one year).
  • Tdap (adult) one dose / Td or Tdap vaccine within the past 10 years
  • Polio primary series

• COVID-19 Vaccine Medical and Religious Exemption Form
  Note: Religious exemptions will not be accepted after the add/drop deadline of each semester. Do not upload or send after that time frame.
• Physician Forms and Guidelines for Requesting Medical Exemptions of Required Vaccines

Questions?

Call the Immunization Information Line at (973) 290-4388. For additional assistance, contact Health Services at (973) 290-4132.

Forms

• Graduate & Continuing Studies State of NJ & SEU Medical Requirements
• Authorization to Release Medical and Immunization Documents to SEU
• Authorization to Release Medical Information from SEU

Please download and print a copy of the University's and State Health Forms which includes the following items:

• Required Form 1 - Health Form
• Required Form 2 - Immunization Record
• Required Form 3 - Meningitis Information Sheet
• Recommended Form 4 - History and Physical Form

Complete Forms 1-3 in its entirety and have your physician complete their portion.

• Fall semester deadline is June 1 - or immediately upon enrollment
• Spring semester deadline is November 15 - or immediately upon enrollment

Send or fax your completed forms to:

SEU Health Services
Founders Hall
2 Convent Road
Morristown, NJ 07960

Fax: (973) 290-4182.

Health and Immunization Requirements

The following are the basic requirements for the graduate and continuing studies students. Please refer to the instruction portion of the forms for more detailed information.

Please Note: SEU undergraduate alumni who are enrolling as graduate students must submit the current Health Form.

• COVID-19 vaccine series and boosters
• You are required to fill out the identification sheet
• All must read the Meningococcal Vaccine Information Statement and complete and sign the Meningitis Information Sheet.
• For students born after 1956, you must provide documentation of:
  • 2 measles vaccines
  • 2 mumps vaccines
  • 2 rubella vaccines
• For students taking 12 or more credits in any semester, you must provide documentation of:
  • 3 Hepatitis B vaccines (or series of 2 Heplisav)

• COVID-19 Vaccine Medical and Religious Exemption Form
  Note: Religious exemptions will not be accepted after the add/drop deadline of each semester. Do not upload or send after that time frame.
• Physician Forms and Guidelines for Requesting Medical Exemptions of Required Vaccines

Questions?

Call the Immunization Information Line at (973) 290-4388. For additional assistance, contact Health Services at (973) 290-4132.

All potential athletes must in addition have a Pre-participation Athletic History, Physical and clearance completed by their physician prior to entrance and participation and within six months.

Please refer to the Athletic Department Admission Requirements for forms and information. For further information contact Tom Wagenblast, Athletic Director at (973) 290-4207.

• Athletic Pre-Participation Physical Examination Form
• Student Athlete Forms
• COVID-19 Vaccine Medical and Religious Exemption Form
  Note: Religious exemptions will not be accepted after the add/drop deadline of each semester. Do not upload or send after that time frame.
• Physician Forms and Guidelines for Requesting Medical Exemptions of Required Vaccines

Forms

• Department of Nursing & SEU Medical Requirements
• Authorization to Release Medical and Immunization Documents to SEU
• Authorization to Release Medical Information from SEU

Please download and print Nursing Students - Department of Nursing & Saint Elizabeth University Medical Requirement form which includes the following items:

• Required Form A - Health Form - identification, history, physical, Health Care Provider Attestation
• Required Form B - Immunization Record
• Required Form C - Meningitis Information Sheet
• Required Form D - Authorization to release health, immunization, laboratory, testing and TB screenings

To begin clinical rotations, you must receive a Health Clearance Form from the nursing program chairperson. Complete Forms A - D in its entirety and have your physician complete their portion.

• Fall semester deadline is June 1
• Spring semester deadline is December 1

Complete and send, fax or upload to:

Health Services
Saint Elizabeth University
Founders Hall
2 Convent Road
Morristown, New Jersey 07960

Upload:
www.steu.edu/meduploads
Phone: (973) 290-4132
Fax: (973) 290-4182

For questions about nursing medical requirements and clinical clearance please contact the nursing department:

Nursing Program
Health and Immunizations
Saint Elizabeth University
Henderson Hall
2 Convent Road
Morristown, New Jersey 07960
Attn: Dr. Virginia Clerkin
Phone: (973) 290-4570
Email: vclerkin@steu.edu

University Health and Immunization Requirements

The following are the requirements for nursing students. Please refer to the instruction portion of the forms for more detailed information.

• You are required to fill out the identification sheet.
• You and your physician are required to complete the Medical History and Physical Forms.
• The provider must complete the Health Care Provider Attestation Form.
• You and your physician are required to complete the immunization form.
• The immunization requirements are as follows:
  • COVID-19 vaccine series and boosters
  • MMR vaccine 2 doses or 2 measles, 2 mumps and 2 rubella vaccines and/or positive titers (must include a copy of lab results within 5 years).
  • Meningitis ACWY vaccine
    • Students less than or equal to 21 years old and all resident students
    • Final dose must be administered at or after the age of 16 AND within 5 years of entry
  • Meningitis B vaccine less than 23 years old
  • All must read the Meningococcal Vaccine Information Statement and complete and sign the Meningitis Information Sheet and return it to Health Services.
  • 3 Hepatitis B vaccines (or series of 2 Heplisav) and/or positive titer (must include a copy of lab results)
  • Hepatitis C screening
  • Inteferon-gamma release assay test (IGRA) or PPD/Mantoux testing (within six months)
    • PPD/Mantoux 2 step
      • Plant date and the read date is required.
      • Reading needs to be in millimeters of induration.
    • IGRA – copy of lab request required
    • If you have a history of a positive PPD/Mantoux or IGRA, you need a chest x-ray (within one year).
  • Tdap (adult) one dose / Td or Tdap vaccine within the past 10 years
  • Varicella vaccine 2 doses or history of the disease and positive titer (must include a copy of lab results)
  • Polio primary series
  • COVID-19 Vaccine Medical and Religious Exemption Form
    Note: Religious exemptions will not be accepted after the add/drop deadline of each semester. Do not upload or send after that time frame.
  • Physician Forms and Guidelines for Requesting Medical Exemptions of Required Vaccines

  Questions?

  For general college health requirements, contact Health Services at (973) 290-4132 or email immunization@steu.edu.
  
  For questions about nursing medical requirements and clinical clearance, please contact Dr. Virginia Clerkin at (973) 290-4074 or vclerkin@steu.edu.

Forms

• State of N.J. & SEU Physician Assistant Program Medical Requirements
• Authorization to Release Medical and Immunization Documents to SEU
• Authorization to Release Medical Information from SEU

Please download and print a copy of the Medical Requirement forms for the Physician Assistant Program which includes the following items:

• Required Form A - Health Form
• Required Form B - Immunization Record
• Required Form C - Meningitis Information Sheet
• Required Form D - Authorization to Release Immunization and TB Screenings

University Health and Immunization Requirements

• COVID-19 vaccine series and boosters

Please read the instructions carefully. Complete and send a copy of all required forms to:

SEU Health Services
Founders Hall
2 Convent Road
Morristown, NJ 07960

Immunization Info Line: (973) 290-4388
Fax: (973) 290-4182
 

• COVID-19 Vaccine Medical and Religious Exemption Form
  Note: Religious exemptions will not be accepted after the add/drop deadline of each semester. Do not upload or send after that time frame.
• Physician Forms and Guidelines for Requesting Medical Exemptions of Required Vaccines

Questions?

For additional assistance, contact Health Services at (973) 290-4132.