This form must be completed by all students before the start of Fall term. If you do not complete this form, you will not be allowed to sit for classes.
Please note: to complete this form, you must have a copy of your immunization record AND proof of health insurance available to upload. The form cannot be completed without these two items.
If you have any questions regarding this form or the information requested, please contact the Director of Student Health Services, Tonya Marksberry, at firstname.lastname@example.org or 270-852-3288. All information contained in this form is confidential as defined by HIPAA regulations.