Student Required Health Forms

Please review new health forms checklist and Massachusetts state requirements prior to completing the forms below.

All undergraduate students are required to submit:

• Student Medical History (PDF)
• Immunization Record (PDF)
  • When you upload your forms into the online secure patient portal please input the dates you received each immunization as listed on your record. 
• Meningitis Waiver (PDF) for students who choose to waive the vaccine.
• TB Risk Assessment (PDF)
• Physical Exam Form (PDF): If you’re unable to have your provider fill out this form, but have had a physical done within the last year, please submit what you have and we’ll let you know if we need more information.
• NCAA Requirements must be followed by WPI varsity athletes. Please have your primary care physician complete the required forms, or you’ll be excluded from participating in sports.
• Consent to Treat Minor Form (PDF): This form is required if you’ll be under 18 prior to the start of the academic year.

Please review new health forms checklist and Massachusetts state requirements prior to completing the forms below.

All graduate students are required to submit:

• Immunization Record (PDF)
• Meningitis Waiver (PDF) for students who choose to waive the vaccine.
• TB Risk Assessment (PDF)
• Physical Exam Form (PDF): If you’re unable to have your provider fill out this form, but have had a physical done within the last year, please submit what you have and we’ll let you know if we need more information.

WPI provides a process for students to submit a request for a medical or religious exemption for all required vaccinations. Students must complete a Vaccine Exemption Form and specify whether they are asking for a medical or religious exemption. If a student requests a medical exemption, they must upload a Medical Provider Exemption Letter from their healthcare provider in addition to the Vaccine Exemption Form. See the instructions below. 

To access and upload the exemption form, please complete the following steps: 

1. Download, print, complete, and sign the Student Vaccination Exemption Form. 
2. To upload the completed form, log into the WPI Student Health Portal 
3. Select the upload tab; scroll down to see the drop-down list of documents available for upload. 
4. Select "Student Vaccine Exemption Form" and upload the completed exemption form. 
5. Select "Medical Provider Exemption Letter" from the drop-down list, select file, and upload the exemption letter if required.  

Please log-in to the secure health portal to upload these forms. Each form must be completed before arrival to campus. Students can also upload their COVID-19 pre-boarding tests in the health portal

Forms can be completed and uploaded to the Student Health Portal. We will only contact you if we require additional information. Please check your WPI emails - we will send you messages in the health portal, but notifications go to your WPI email address. ​Please do not email regarding health forms; it is not a secure way to transmit confidential health information.

FAQ for New Student Health Forms

• What is the best way for me to submit my required health forms? The preferred method is electronic upload to our secure health portal. To log in, use your Banner ID and password. Remember, always keep hard copies of these documents for your records.
• Can you confirm receipt of faxed/uploaded/mailed forms? Unfortunately, we cannot confirm receipt at this time. We ask that students be diligent about checking their WPI email, as we will send secure messages (notification through WPI email) when/if additional documentation is needed. Please be sure to read these emails. If you delay submission of required documents past this summer, it may result in you not being able to register for next term's classes.
• How do I fill out the tuberculosis (TB) risk questionnaire? The tuberculosis risk questionnaire does not need to be filled out by your medical provider, it simply needs their name written in the appropriate space on the form. Please complete the form on your own by checking the applicable boxes. Our staff will review your answers and reach out to you directly if any additional actions need to be taken.
• One of the required vaccines isn't offered in my country: Ideally, we can suggest ways for you to get your vaccine prior to coming to campus, such as going to a travel clinic or urgent care clinic. Otherwise you will have to make arrangements to get your vaccine as soon as you arrive in the United States, however, this is for extenuating circumstances only. Health Services typically arranges vaccination clinics once/year, typically in October, when you can get many of your vaccines (please check with your insurance company regarding coverage of vaccines). Otherwise, it will be your responsibility to get all of your required vaccines. 
• I have my own insurance. How do I waive the WPI student health insurance? Please contact the Bursar’s Office through email or at 508-831-5203 for more information on waiving the WPI student health insurance.
• Will you accept my doctor’s office’s forms for physical exams and/or immunizations? As long as the physical is within the last calendar year and signed (electronic or e-signature is fine), we will accept them. Immunization records also need to have a signature of authorized personnel. If you had titers drawn because you do not have documentation of vaccines or illnesses, please also submit these blood results.