Student Health Services Forms

Forms/Immunizations required upon Admission, Due: May 1st, 2013

• Online Medical Insurance Fee Waiver-NOW OPEN!!! You Could Save $1,300! If you have Health Insurance that meets CMA Requirements please complete a waiver.
• CMA Health Report
  • For more information regarding USCG Medical, Psychological & Physical Guidelines please view the NVIC Standards (Navigational Vessel Inspection Circular) 2008: 04-08.

• Hepatitis B Immunization Requirements (AB 1107)
• Meningococcal Disease and Immunization (AB 1452)
• Two MMR/MMRV (Measles, Mumps, Rubella & Varicella), Polio vaccination history, TD/Tdap history & current vaccine within the last 5 years & TB Skin test within the last 6 months.
• Abridgement of Drug Testing Form
• Athletic Physical Forms (Page 4 of Health Report)

Employee Cruise Physical Forms

• Employee Cruise Physical

U.S. Coast Guard Physical Forms

• Merchant Mariner's Physical Exam Report (CG-719K)
• Merchant Mariner's Certification of Fitness for Entry Level Ratings (CG-719K/E)

Miscellaneous Forms

• Abridgement of Drug Testing Form
• Consent for Medical Release
• Immunization Exemption Form
• Fee Summary