Medical Forms

Health Form:

Immunization Record and Medical Information Form

To assist the college in providing appropriate care, all undergraduate students are required to submit a completed six-page health form as provided by the college admissions office at the time of admission. PLEASE schedule an appointment with your provider to have your medical form completed as soon as possible. See page 6 of the form for submission options including via secure fax, 276-944-6666, or email our staff for other options.  Varsity athletes, outdoor adventure team, equestrian riders, rugby, and cheer & dance program participants must complete additional paperwork online through the ARMS system.

For any incomplete items on submitted forms, you will be contacted through your Emory & Henry College EMAIL address.

*For School of Health Sciences graduate requirements see individual program information*

Minimum Required Immunizations or Proof by Titer:

  • Coronavirus (REQUIRED FOR SPECIFIC GROUPS—see section below)
  • MMR (Measles/Mumps/Rubella)
  • Polio
  • Tetanus-Diptheria (Td or Tdap) Booster must be within past 10 years

Commonwealth of Virginia Certificate of Religious Exemption Form must be completed and notarized if you have not received required immunizations: https://www.doe.virginia.gov/support/health_medical/certificate_religious_exemption.pdf 

Strongly Recommended Immunizations:

  • Current year Influenza
  • Hepatitis A and B
  • Meningococcal (Quadrivalent and B)
  • Varicella
  • HPV (Human Papillomavirus)

Specific Coronavirus Vaccine Information

An FDA approved coronavirus vaccine (basic series plus booster), whether still in Emergency Use Authorization status or not, will be required for all students under the following circumstances:

  • Students living in College-owned residential facilities
  • Students that are members of an NCAA athletics team; Students involved with any affinity group or club sport; Student members of the equestrian team
  • Students involved in any active student organization, to include fraternity and sorority life, and any student organization recognized by the Student Government Association
  •  Students that are representing the college in any visual or performing arts program
  • All School of Health Science students
  • All School of Nursing students

Students that are on the Emory campus will need to report their vaccination status no later than July 1st (due date for the required “E&H Immunization Record and Medical Information Form”). Coronavirus vaccinations should be recorded on page 6 of the form. A copy of your coronavirus vaccination card may be attached. 

Students at the School of Health Sciences should upload their vaccination status in E-Value by August 1st. If you do not have access to this link, please consult with Dr. J.P Barfield.

Students at the School of Nursing should also upload their vaccination status in Castlebranch. If you do not have access to this link, please consult with Dr. Laurie Anne Ferguson.

Exemption Forms

Students may submit a notarized religious exemption form OR submit a request for a medical exemption by completing this form.  Please note that all medical exemption requests require documentation from a healthcare professional (MD, DO, NP or PA) and will be reviewed before you are notified of approval or denial. Should you be granted an exemption, you will be required to wear a facial covering at all times in enclosed spaces until the CDC indicates otherwise.

If you have any questions, please do not hesitate to reach out to Ryan Bowyer at rbowyer@ehc.edu.

Find a vaccination location near you: https://www.vaccines.gov/search/