New students who are age 19 or older must complete this form; students who are younger than 19 must have this form completed by a parent or guardian.

Information shared on this form will be kept confidential and will be shared with appropriate College personnel on a need-to-know basis only.

The following documents are necessary to complete this form:
  • Student’s immunization record (copy uploaded to computer)
  • A list of surgeries and significant illnesses
  • A list of the student’s medications
  • Health insurance card (copy front and back uploaded to computer)

If you require assistance with completion of this form or if you have any questions, please contact the Office of Health Services at (334) 833-4440.

Student Health Form

  • MM slash DD slash YYYY
    mm/dd/yyyy
  • MM slash DD slash YYYY
  • NOTE: If the student is younger than age 19, this form must be completed by the student's parent or guardian
  • Student Information

  • Medical Documentation

  • Max. file size: 300 MB.
    To upload the student's immunization record, obtain the record from the student's physician, scan and save it to your hard drive, then select the file to upload it to the website. If you are unable to complete this process, you may send the original immunization record to the Huntingdon College Office of Admission, 1500 E. Fairview Ave., Montgomery, AL 36106.
  • Tuberculosis Questionnaire

    Some of the questions below pertain to the following countries, which have a high prevalence of TB disease: Afghanistan, Algeria, Angola, Argentina, Armenia, Azerbaijan, Bahrain, Bangladesh, Belarus, Belize, Benin, Bhutan, Bolivia (Plurinational State of), Bosnia and Herzegovina, Botswana, Brazil, Brunei Darussalam, Bulgaria, Burkina Faso, Burundi, Cabo Verde, Cambodia, Cameroon, Central African Republic, Chad, China, Colombia, Comoros, Congo, Côte d'Ivoire, Democratic People's Republic of Korea, Democratic Republic of the Congo, Djibouti, Dominican Republic, Ecuador, El Salvador, Equatorial Guinea, Eritrea, Estonia, Ethiopia, Fiji, Gabon, Gambia, Georgia, Ghana, Guatemala, Guinea, Guinea-Bissau, Guyana, Haiti, Honduras, India, Indonesia, Iran (Islamic Republic of), Iraq, Kazakhstan, Kenya, Kiribati, Kuwait, Kyrgyzstan, Lao People's Democratic Republic, Latvia, Lesotho, Liberia, Libya, Lithuania, Madagascar, Malawi, Malaysia, Maldives, Mali, Marshall Islands, Mauritania, Mauritius, Mexico, Micronesia (Federated States of), Mongolia, Morocco, Mozambique, Myanmar, Namibia, Nauru, Nepal, Nicaragua, Niger, Nigeria, Niue, Pakistan, Palau, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Qatar, Republic of Korea, Republic of Moldova, Romania, Russian Federation, Rwanda, Saint Vincent and the Grenadines, Sao Tome and Principe, Senegal, Serbia, Seychelles, Sierra Leone, Singapore, Solomon Islands, Somalia, South Africa, South Sudan, Sri Lanka, Sudan, Suriname, Swaziland, Tajikistan, Thailand, Timor-Leste, Togo, Trinidad and Tobago, Tunisia, Turkey, Turkmenistan, Tuvalu, Uganda, Ukraine, United Republic of Tanzania, Uruguay, Uzbekistan, Vanuatu, Venezuela (Bolivarian Republic of), Viet Nam, Yemen, Zambia, or Zimbabwe.
  • Medical History

  • To choose more than one, hold down the Control key on your keyboard.
  • Example: grandparent: high blood pressure; sister: congenital heart disease; mother: cancer
  • Health Insurance

    As of January 1, 2014, federal law requires health insurance for every individual. Huntingdon College strongly recommends that every student be covered by health insurance.
  • Max. file size: 300 MB.
  • Signatures

  • Student: please sign this form by writing your name.
  • Parent/Guardian: Please sign this form by writing your name.
Scroll to Top
Close Menu