Forms

All forms require Adobe Acrobat Reader to view or print.

REQUIRED ENTRANCE FORMS:

Depending on what type of student you are (Resident, Commuter, Nursing, Off-Site), there are different requirements. Please read the descriptions below to complete and submit the appropriate forms.

RESIDENT STUDENTS:

Student Profile, Health History, Physical Exam, Meningitis Response, Resident Student Immunization Record

COMMUTER STUDENTS:

Student Profile, Health History, Physical Exam, Commuter Student Immunization Record. Meningitis Information for Commuters is located on the Immunization Record.

NURSING STUDENTS:

Student Profile, Health History, Physical Exam, Meningitis Response Form, Nursing Student Immunization Record

OFF-SITE STUDENTS:

Off-Site Student Immunization Record **This form is for students taking classes ONLY at a Non-Metro/Florham Campus location**


Entrance Form Packets for Download:

RESIDENT PACKET

Download

COMMUTER PACKET

Download

NURSING PACKET

Download

OFF-SITE

Download

Individual Forms for Download:

Cover Letter

Download

Student Profile

Download

Health History

Download

Meningitis Response

Download

Physical Examination

Download

Resident Student Immunization Record

Download

Commuter Student Immunization Record

Download

Nursing Student Immunization Record

Download

Off-Site Student Immunization Record

Download

Important information to remember when submitting required entrance forms:

  • Mail your own Health Forms and do not rely on Doctors’ offices and schools to mail it for you. Too often we never receive it.
  • Do not fax us your Health Forms. Faxed Health Forms are often illegible and the pages can get easily misplaced.
  • Please keep a copy of the completed forms for your personal record before mailing all original documentation to Student Health Services.          
  • Students will not be permitted to register for class or to reside in FDU housing until the health forms and immunization records are completed and received.
  • All forms submitted MUST be in English.


 OTHER FORMS:

Positive TB Test Checklist

Download

Symptom Assessment for Pulmonary Tuberculosis (TB) - Nursing Students Only

Download

Positive TB Test Checklist

For students with a positive TB Test result, the Positive TB Test Checklist must be filled out by your healthcare provider. Students who do not submit this form will not be medically cleared and will not be able to register for classes.

Symptom Assessment for Pulmonary Tuberculosis (TB)

This form is for nursing students with a history of a positive TB test. This form is to be completed at the time of the nursing student's annual physical exam.

 

Medical records are strictly confidential and are not part of the academic records. Medical records are used exclusively by Student Health Services Metro to provide personalized care. Any information on these records or concerning a visit to Student Health Services Metro will not be released without written permission from the individual treated. Immunization records are an exception and are not confidential since your immunization status must be made available to New Jersey State Inspectors and select University offices in order to comply with New Jersey State Law.