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Required Health Forms

Health History and Pre-Matriculation Certificate of Immunizations

Widener University’s Pre-Matriculation Immunization Policy requires all incoming Freshmen, International, Transfer, and Graduate (PT, PSY.D., and MSW) students to provide Student Health Services with the following health and immunization information. A healthcare provider’s signature is only required when filing for a medical exemption. Failure to comply with this process will jeopardize a student’s standing with the university.

Required Immunizations

Immunization records must be attached.

  • Tetanus/Diphtheria/Pertussis (Tdap) Booster — Must be within the last 10 years
  • Measles, Mumps and Rubella (MMR)Two documentation options: Two dates of MMR vaccination or laboratory evidence of immunity (must submit titer result).
  • Varicella (Chicken Pox)Two documentation options: Two dates of Varicella vaccination or laboratory evidence of immunity (must submit titer result).
  • Meningitis — Vaccine is required for undergraduate students under the age of 23 years old. Administration must be within the past 5 years. Two dates of Meningitis vaccination required.
  • Hepatitis BTwo documentation options: Three dates of Hepatitis B vaccination or laboratory evidence of immunity (must submit titer result).
  • Tuberculosis Screening— Must be within 1 year of your arrival at Widener University, regardless of BCG Inoculation. Three documentation options: PPD (Purified Protein Derivative), Quantiferon TB Gold (must submit titer result), or T-Spot/Interferon gamma release assay (IGRA) (must submit titer result).

All required and suggested vaccines are available and administered at Student Health Services.

Related Forms

Sickle Cell Testing Requirements

All incoming NCAA student-athletes (freshman and transfers) must do one of the following to meet the university sickle cell trait status requirement:

    • Provide test results of prior Sickle Cell Trait testing to the Health Services; OR
  • Get tested for Sickle Cell Trait and submit the test results to Health Services

Note: A copy of the sickle cell trait laboratory result must accompany the completed Athletic Physical Examination Form and needs to be drawn prior to the first practice. This service can be provided at Student Health Services. 

Athletic History/Physical Form

In accordance with the NCAA and Widener University requirements, all athletes or potential athletes (freshmen and/or upperclassmen transfers) must have an Athletic Physical Examination Form completed by their personal healthcare provider prior to a student's Varsity/Junior Varsity Sport first practice. This physical must be performed no more than six months prior to first team practice. Noncompliance will result in the athlete's ineligibility to participate in a sport. The Athletic Physical Examination Form can be obtained from the Athletic Department.

Widener University's Athletic Department — in conjunction with the NCAA Medical Exemption Banned Stimulant Policy — requires strict documentation regarding the use of stimulant medications. This documentation must demonstrate that the student-athlete has had a recent clinical assessment, is routinely monitored for use of stimulant medication, and has a current prescription on file in Student Health Services in order to be approved for a medical exemption to the banned drug policy. Failure to comply with this requirement could keep an athlete from participating in their chosen sport for up to one year should you have a positive drug test, as a result of the NCAA's Year Round Drug Testing Program. The Medical Exemption Banned Stimulant Form is attached to the Athletic Physical Examination Form packet. Hard copies are also available at Student Health Services and the Athletic Department. All HIPPA requirements will be met for the transmission of this medical information.

Club Sports

A physical exam must be performed each academic year for all new and returning club sport athletes prior to first practice.  This examination will be performed by a health care provider of the student's choice and paid for at the student's expense.  This physical must be performed no more than six months prior to the first team practice.  The Athletic Physical Examination Form can be obtained from the Pride Recreation Center.  Completed forms must be submitted to Student Health Services.  All new club sport athletes must complete an Impact test; please call Student Health Services to make an appointment and complete the test.

Release of Records

Medical records are released only with the completion of a Widener University Health Services Release of Information Form. Requests for copies of medical records require a 48-hour waiting period.