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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 health care 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).
  • Tuberculousis Screening— Must be within 1 year of your arrival at Widener University, regardless of BCG Inoculation. Three documemtation 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.

Sickle Cell Testing Requirements

All incoming 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 (testing must be done prior to arrival on campus)

Note: A copy of the sickle cell trait laboratory results must accompany the completed history and physical form.

Club Sports

All club sport participants must also meet this university requirement.

Note: This examination will be performed by a health care provider of the student's choice and paid for at the student's expense. The examining provider must sign the completed physical examination form and place his/her office stamp at the bottom left-hand corner.

Related Forms

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 a Sports Physical Examination Form completed by their personal health care 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. All club sport participants must also meet this university requirement.

Athletic Physical Form (PDF)

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 available on both the Student Health Services and Athletic Department websites. All HIPPA requirements will be met for the transmission of this medical information.

Student Athlete Stimulant Documentation (PDF)

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.