Welcome to Austin College! These forms are both required and time-sensitive. Failure to complete the required information could affect your ability to move into your residence hall, participate in on-campus activities, or attend class. However, we are always happy to answer questions and help in any way possible. Please feel free to contact us for more information regarding Health Services by calling 903.813.2247 or email Health Services.
The following items in your Health Form 2016-2017 Packet (pdf) must be returned by July 1, 2016.
- Personal and Family History Form
- Physical Examination Form
- Immunization Form
- Mental Health History Form
- Disability Accommodations Form (May be mailed directly to the Academic Skills Center)
- Authorization Form
- Copy of the front and back of your current insurance card
The final page of the packet provides the following for your information – no need to return:
- 2016-17 Student Health Insurance Plan Highlight Flyer
- Instruction sheet for online waiver or enrollment (Waiver must be completed ONLINE by July 1)
COMPLETE Health Packets may be returned:
Mail: Health Services
900 N. Grand Ave, Ste. 61629
Sherman, Texas 75090
Email: You may request a secure email link by calling 903.813.2247 or sending an email to email@example.com.
Austin College requires all enrolled students to have valid health insurance. All students must go to Academic Health Plans and either “Enroll” or “Waive” enrollment. Waiving requires that you provide current insurance information for verification no later than July 1, 2016. Please be sure to upload a copy of the front and back of your insurance card on the waiver form.
For those who choose to enroll in the health plan, the annual premium of $1996.00 will be added to your student account. The plan is underwritten by National Guardian Life Insurance Company (Not Affiliated with The Guardian Insurance Company) and covers care provided at the Austin College Clinic as well as a large array of in-network providers. For a summary of this plan, see Insurance Highlights or you may call toll free 855.370.7215 to speak with an academic health plan representative.
Personal and Family History: To the best of your ability, please carefully complete.
PHYSICAL EXAMINATION FORM / IMMUNIZATION FORM
Physical Examination: A licensed Physician, Nurse Practitioner or Physicians’ Assistant must complete and sign the Physical Examination form on page 1.
Immunization Record: Your physician or their representative must complete and sign the immunization information on page 2. A copy of other school records immunizations will suffice, providing it meets all of our requirements.
MENTAL HEALTH HISTORY FORM
Since mental health issues can influence adjustment and academic success in college, it is important for those with a need to know to be informed of prior mental health issues and treatment. The Austin College Counseling Services provides crisis intervention, short term counseling and referral assistance for all students. To the best of your ability, please carefully complete this form. See more information regarding Counseling Services or contact 903.813.2247.
DISABILITY ACCOMMODATIONS FORM
Students with documented disabilities who wish to utilize classroom accommodations are required to register with the College through the Office of the Vice President for Student Affairs. It is the student’s responsibility to provide written documentation of the disabling condition, the impairment(s) the condition causes, and recommended accommodations. Determination of eligibility for services and of appropriate accommodations is made on an individual case-by-case basis. To the best of your ability, please carefully complete this form. See more information regarding Disability Accommodations or call 903.813.2454.
AUTHORIZATION SIGNATURE AND EMERGENCY CONTACT FORM
Please review and sign the top white copy writing firmly enough to copy through to the pink and yellow pages.All areas must be completed and signed by the student OR by both the student and the parent/legal guardian if the student is less than 18 years of age.
You are encouraged to carefully check your family’s insurance policy. If it does not cover intercollegiate sports, it is recommended that you purchase the student insurance plan underwritten by National Guardian Life Insurance Company (Not Affiliated with The Guardian Insurance Company). If you choose to use your family’s insurance plan, please include a photo copy (front and back) of your insurance card with this packet before July 1, 2015, in addition to the online waiver form.
Athletes are not permitted to participate in their team’s activities prior to submission of all the required forms. From June 1 through August 1, please contact Julie Travis or call 903.813.2499, if you have any questions. After August 1, contact the athletic trainer, Evan Gumpert or call 903.813.2514 if you have any questions.
All other questions regarding your health packet can be answered by calling Adams Center at 903.813.2247 or emailing firstname.lastname@example.org. Many of these forms can also be downloaded below: