Forms for Download

All new students are required to submit a health questionnaire and immunization information. All needed forms are available for download here in .pdf* format.

Tennessee law requires that all new in-coming students either receive the hepatitis B and meningococcal vaccines (living in on-campus housing) or sign a waiver indicating that they do not wish to receive the vaccines. While the institution is not required to provide the vaccines and/or reimbursement for them, both can be purchased and administered at the Student Health Center.

If you are over 18 and would like to waive or enter your meningococcal and hepatitis B vaccine status, please click here www.kosterweb.com and select "Vanderbilt University" from the pull down menu.

If you are under 18, you will need to print the waiver forms (see links below labeled "Tennessee Hepatitis B and Meningitis Vaccine Letter and Waiver Forms"), have a legal guardian sign the form, and mail the form to the Student Health Center at the address provided at the bottom of the page.

• Undergraduate Student Insurance Brochure
• Graduate/Professional and International Student Brochure
• Scholastic Emergency Services
• Authorization for Release of Information form
• Request for Medical Information form
• Revocation of Authorization form
• Medical Leave of Absence Student Insurance  Enrollment Form
• Women's Health History
• Animal Allergy Questionnaire
• Interim/Orientation Insurance Plan Application
• Gallagher Koster Dependent Health Insurance Application
• Gallagher Koster Medical Evacuation and Repatriation Insurance Application
• Gallagher Koster Supplemental Health Insurance Application
• Medical Evacuation and Repatriation of Remains Insurance Application
  

Student Health Center | Vanderbilt University
Zerfoss Building, MCN | 1161 21st Ave. S. | Nashville, TN 37232
615.322.2427 | (fax) 615.343.0047

Copyright © 2007 by Vanderbilt University. Site maintained by the webmaster. Last edited 5/25/07