Forms and Immunizations

Immunization Requirements

No physical exam is required, however, Illinois law does mandate that all incoming students born AFTER 1956 show documented proof of immunity to measles, rubella, mumps and tetanus/diphtheria and must have verified documentation of their immunization history on file in the Health Service office. Please provide 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 the health department. All international students should make every effort to obtain this medical history before coming to the US.

All information must be completed and on file in the Student Health office by the start of classes your first semester. Failure to meet this requirement will result in a $25 late fee which will be applied after the first two weeks of classes and a delay in registration for your second term.

INSTRUCTIONS: Download the Student Health form or if you are an international student, the International Student Health form.

  • Please type in the  requested information on page one and the top portion of page two.(Name, birth date, and country of birth) You cannot type in the immunization dates, this must be completed by your doctor/nurse OR
  • Request a copy of your immunization records from either your high school or your doctor's office
  • Print the form
  • Sign and date the Consent for Treatment
  • Bring the completed form to the Student Health Office in  Krasa Center 116 or

 Mail to:

Student Health Services
Benedictine University
5700 College Road
Lisle, IL 60532

Or fax to: 630-829-6035

Because this form requires signatures, you are not able to submit it electronically.

Tetanus/diphtheria  or Tdap, and TB tests are available in the Health Service.

Please call us if you have any questions about this requirement at (630) 829-6046.

STUDENT ATHLETES: This required information is separate from the athletic forms. We do not share medical records with the athletic trainers. Please make sure you complete the Health Service form as well as all those in your athletic package. Our form does not require a physical exam from your doctor.

CURRENT STUDENTS AND RECENT ALUMNI You may obtain a copy of your immunization record by logging into "My BenU". Go to "Self Service, CampusPersonal Information, Immunization Report", and print.

Contact Information
Location:  Krasa 116
Phone:  630-829-6046
Fax:  630-829-6035
E-mail:  studenthealth@ben.edu