This is a two-part form to be filled out by the student and their licensed health care provider. The form can be completed and submitted online, or downloaded here and returned to the College by mail.
Students: Complete the top section and click the orange text “Save and Continue” to generate a link that you can automatically email or give to your provider so they can complete and submit the remainder of the form.
Providers: Complete the provider portion section and click the gray SUBMIT button to finish the process.