Enrolling with Health Services is Simple.

New students must complete several health forms in order to enroll at Cornerstone University. Please view the entrance requirements for a health services checklist.

All Cornerstone University students, whether residing on or off campus, are required to:

If this information is not submitted to Student Health Services before the deadline and you have not contacted Health Services to get an extension, Cornerstone University will place a hold on the student's registration and assess a non-refundable $50 medical fee. The student will be unable to enroll until the requirements are completed. If a student is unable to complete these requirements by the stated deadline, they must contact Health Services to get an extension via email or by phone (616.222.1441).

Medical Health History Form

The medical history form assists the medical staff in knowing health conditions the student has previously had or is currently dealing with, so that preventative accommodations or proactive health care may be given.

Health History Form

Proof of Immunity

Cornerstone University, in practicing best medical practices and in compliance with Michigan law, requires that students demonstrate proof of immunity with respect to measles, mumps, rubella (MMR), polio, tetanus, diphtheria, pertussis, hepatitis B, and meningitis. In addition, the University requires that students self-screen for Tuberculosis and if necessary provide proof of a negative TB test. The immunization record must either be signed by a health care professional, stamped with their official stamp or provide an official document from the State’s registry or from the student’s previous school.

Proof of immunity is evidenced by either appropriate documentation of immunization, physician-diagnosed disease leading to immunity or serologic testing (blood tests). Information regarding the specific vaccinations and other documentation required to establish proof of immunity is available from Student Health Services.

Required Immunizations

These must have official documentation:

  • Three childhood doses of DPT (diphtheria, pertussis, tetanus) or any combination of these single antigens with an additional booster of Tdap (Tetanus with Added Pertussis) given a minimum, of every 10 years.
  • Students must provide documentation of two live MMR vaccines, with the 2nd dose given after 4 years of age.
  • Hepatitis B is a series of 3 doses given over a period of 6 months.
  • Varicella (Chicken Pox) is a two-shot vaccination series recommended for students who have not previously had the chicken pox disease. Students must provide documentation of having the vaccination series or having the disease.
  • Minimum of four doses of Polio vaccine, with the 4th dose given after 4 years of age.
  • Meningococcal meningitis, all unvaccinated teens should receive a dose between ages 13 and 18yrs; if vaccinated at age 13 to 15 yrs, a booster at age 16 to 21 yrs is required. Not required over age 22 yrs.

Immunization History Form

Immunization Exemption

All religious or medical exemptions must be in writing on a separate sheet. By Michigan State law, a student may be exempt from immunizations for one of only two reasons: medical or religious. Medical exemptions must be signed by a physician. Religious exemptions must include a signed statement from the student stating the exact religious reasons for the requested exemption. If the student is a minor, the student must complete the statement with their signature and the signature of parent or guardian. Please note: further documentation and a review process will be necessary if exemption option is selected. Read more about our immunization exemption policy.

Immunization Waiver Form

Tuberculosis Screening

All students are screened for tuberculosis (TB). If you answer yes to any of the screening questions you must get a TB skin test. The results of the TB test need to be provided to UHS. If you have tested positive for TB in the past, do not take the skin test again. Those who have previously had a positive TB skin test or who received the BCG vaccine as a child must provide a negative chest x-ray.

Tuberculosis Self-Screening Tool

Authorization to Treat Form

Please Note: This form needs to be signed by the student and parent or guardian if the student is under 18 years of age. Also, please attach a copy of your insurance card with the form.

Helpful Resources