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Hilbert College
Office of Admissions
5200 South Park Ave.
Hamburg, NY 14075

Franciscan Hall, First Floor  
716-926-8780
1-800-649-8003
admissions@hilbert.edu

OFFICE HOURS
Monday-Thurs: 8:30 a.m.-5 p.m.
Friday: 8:30 a.m. - 4:30 p.m.

Enrollment Kit - Student Medical Form

REQUIRED OF ALL FULL-TIME STUDENTS. MUST BE SUBMITTED PRIOR TO THE START OF CLASS. 
XX/XX/XXXX
Street, City, State, Zip Code
XXX-XXX-XXXX

PROOF OF HEALTH INSURANCE

Health Insurance is MANDATORY for all student-athletes and on-campus resident students. Proof of personal health insurance is required prior to moving into the residence halls. Learn more, if you do not have health insurance or have additional questions about health insurance.
Upload Copy of Insurance Card (FRONT of card - PHOTO)
Upload Copy of Insurance Card (BACK of card - PHOTO)

IMMUNIZATIONS

Immunizations are MANDATORY for all students and must be submitted prior to the start of class. On-campus resident students must have their shots prior to moving into the residence halls.

New York State Public Health Law states that all students who are registered (full-time) and were born on or after Jan. 1, 1957 are required to submit verification of immunization for one mumps, one rubella and two measles prior to attending Hilbert College. If we have not received proof of immunization we are mandated to prohibit you from attending classes. Transfer students may submit health records from a prior college. Learn more about immunizations here.
Attached verification records of immunization for one mumps, one rubella and two measles.

MENINGOCOCCAL MENINGITIS VACCINATION

Required of all students living on-campus prior to moving into the residence hall.

Meningococcal Vaccination 

Since 1997, the American College Health Association (ACHA) has urged undergraduate college students, particularly freshmen who live or plan to live in resident halls, to consider getting the vaccine to reduce their risk for meningococcal disease.  Hilbert College requires that all resident students receive the meningitis vaccination.
I have received the meningococcal meningitis immunization within the past 10 years: Attach Vaccination
I will not receive the vaccine: I read and understand the information regarding meningococcal meningitis disease. I understand the risks of not receiving the vaccine. I have decided that I or (my child if under 18) will not obtain immunization against meningococcal meningitis disease.

PHYSICAL EXAMINATION

Required of all resident students in the prior 6 months of living on-campus. Must be completed before moving into the residence hall, without exception. Physical examinations are required of all athletes.

Learn more about Athletic student requirements. Copy of examination form to be completed by a medical professional - Physical Examination Form
Upload physical examination form or medical professional copy here.
 
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FOR MORE INFORMATION
Barb DeLaRosa • (716) 649-7900, ext. 123 • bdelarosa@hilbert.edu
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5200 South Park Avenue, Hamburg, New York 14075
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