Prior to enrollment the deadlines set by Student Health Services, all Cornerstone University students, whether residing on or off campus, are required to:
- Submit a completed medical history form
- Provide proof of immunity as to certain diseases (e.g., through vaccination)
- Complete the Tuberculosis screening tool, and if necessary provide evidence of negative results of a tuberculosis screening.
If this information is not submitted to Student Health Services before the deadline, Cornerstone University will place a hold on the student's registration and assess a non-refundable $50 medical fee. The student will be unable to enroll until the requirements are completed.
If a student is unable to complete these requirements by the stated deadline, they must send their request for an extension via an e-mail to email@example.com.
Medical History Form:
The medical history form assists the SHS medical staff in knowing health conditions the student has previously had or is currently dealing with, so that preventative accommodations or proactive health care may be given. Parents of minors must sign the bottom of the page and fill out the guardian information. See FAQs for Minors for more information regarding minors.
View the Medical History Form (PDF)
Proof of Immunity:
Cornerstone University, in practicing best medical practices and in compliance with Michigan law, requires that students demonstrate proof of immunity with respect to measles, mumps, rubella (MMR), polio, tetanus, diphtheria, pertussis, and hepatitis B. In addition, the University requires that students self-screen for Tuberculosis and if necessary provide proof of a negative TB test. The immunization record must either be signed by a health care professional, stamped with their official stamp or provide an official document from the State’s registry or from the student’s previous school.
Proof of immunity is evidenced by either appropriate documentation of immunization, physician-diagnosed disease leading to immunity or serologic testing (blood tests). Information regarding the specific vaccinations and other documentation required to establish proof of immunity is available from Student Health Services.
These must have official documentation
- Three childhood doses of DPT (diphtheria, pertussis, tetanus) or any combination of these single antigens with an additional booster of Tdap (Tetanus with Added Pertussis) after 2007. Please refer to http://www.cdc.gov/vaccines/pubs/ACIP-list.htm for information on childhood vaccines.
- Students must provide documentation of two live MMR vaccines, with the 2nd dose given after 4 years of age.
- Hepatitis B is a series of 3 doses given over a period of 6 months.
- Varicella (Chicken Pox) is a two-shot vaccination series recommended for students who have not previously had the chicken pox disease. Students must provide documentation of having the vaccination series or having the disease.
- Minimum of four doses of Polio vaccine, with the 4th dose given after 4 years of age.
- Meningococcal meningitis, all unvaccinated teens should receive a dose between ages 13 and 18yrs; if vaccinated at age 13 to 15 yrs, a booster at age 16 to 21 yrs is required. Not required over age 22yrs.
All students are screened for tuberculosis (TB). If you answer yes to any of the screening questions you must get a TB skin test. The results of the TB test need to be provided to UHS. If you have tested positive for TB in the past, do not take the skin test again. Those who have previously had a positive TB skin test or who received the BCG vaccine as a child must provide a negative chest x-ray.
View the TB Self-Screening Tool
In addition to the required immunizations, Cornerstone University, the American College Health Association (ACHA), and the Centers for Disease Control and Prevention (CDC) strongly recommend vaccines against the following:
Gardasil is the only human papillomavirus (HPV) vaccine that helps protect against 2 types of HPV that cause about 75 percent of cervical cancer in girls and young women ages 9 to 26. Gardasil also helps protect against 70 percent of vaginal cancer cases and up to 50 percent of vulvar cancer cases. Gardasil is given as 3 injections over 6 months.
All religious or medical exemptions must be in writing on a separate sheet. By Michigan State law, a student may be exempt from immunizations for one of only two reasons: medical or religious. Medical exemptions must be signed by a physician. Religious exemptions must include a signed statement from the student stating the exact religious reasons for the requested exemption. If the student is a minor, the student must complete the statement with their signature and the signature of parent or guardian. Please note: further documentation and a review process will be necessary if exemption option is selected. Read more about our immunization exemption policy.
Medical History Form (PDF)
TB Self-Screening Tool (PDF)
Immunization History (PDF)
Immunization Waiver (PDF)
Authorization to Treat (PDF)
FAQ about Minors
Authorization to Release Medical Information (PDF)