Forms and Immunization Requirements

Student Health Form

All information must be complete and on file with Student Health Services by the first day of a student’s first semester classes. Failure to meet this requirement will result in a Health Hold on your account. The Health Hold will be applied on the first day of class and will prevent students from adding classes to their schedule or registering for another term.

Instructions
  1. Download the Student Health Services Health Form (PDF) or if you are an international student, download the Student Health Services International Student Form (PDF).
  2. Type the requested information on Page 1 and the top portion of Page 2 (name, birth date and country of birth). You cannot type in the immunization dates. This must be completed by your doctor/nurse OR you may include a copy of your immunization record with both pages of the health form. Request a copy of your immunization records from your high school or doctor’s office.
  3. Print the form from your printer.
  4. Sign and date the Consent for Treatment.
  5. Bring the completed form to Student Health Services in Krasa Center, Room 116 or mail to: Student Health Services, Benedictine University, 5700 College Road, Lisle, IL 60532 or fax: (630) 829-6035.

Please note: Because this form requires signatures, you cannot submit it electronically. Tetanus/diphtheria or Tdap, and TB tests are available in Student Health Services. Please call us if you have any questions about this requirement at (630) 829-6046.

Download Student Health Form (PDF)   Download International Student Health Form (PDF)

Student Athletes

The Student Health Services Health Form and health records requirements are separate from the athletic forms. We do not share medical records with the athletic trainers. Please make sure you complete the Student Health Services Health Form as well as all those in your athletic package. Our form does not require a physical exam from your doctor.

Current Students

You may obtain a copy of your immunization record by logging into My BenU. Go to “Self Service, Campus Personal Information, Immunization Report” and print.

Alumni

Contact Student Health Services at (630) 829-6046 to request a copy of your immunization record. The office is open 9:00 a.m.-4:30 p.m. Monday-Friday during the academic year.

Immunization Requirements

Students are not required to have a physical exam. However, Illinois law mandates all incoming students born after 1956 show documented proof of immunity to measles, rubella, mumps and tetanus/diphtheria and have verified documentation of their immunization history on file in the Student Health Services office. Please provide the month, day and year for each dose administered. If you have no verification of your immunization history, you will need to complete a new series of injections from your family doctor or health clinic. All international students should make every effort to obtain this medical history before coming to the U.S.

Locating Immunization Records

Immunizations are frequently needed for college entry or other post-high school training, future employment or international travel. At this time, there is no national database to maintain this information. If you are unable to obtain a copy of your immunizations, you may have to repeat vaccine doses or have blood drawn to test for immunity for certain diseases.

Some places to check for records:
  • Previous health care providers including public health departments
  • Your home
  • Schools or other four-year colleges
  • Previous employers including the military

Student Health Services

Pam Deely, BSN, RN
Director of Student Health Services

Susan Salerno, BSN, RN
Nurse/Program Coordinator

Krasa Center 116
(630) 829-6046
studenthealth@ben.edu