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International Students (F-1)

International students with an F-1 visa who are attending Kutztown University must complete  required medical forms.  A paper copy of these forms will be mailed to you.  Completion of the  forms must be done whether a student resides in campus housing or a private residence and regardless of intent to utilize Clinical Services. Please return your completed forms at least two weeks prior to your arrival so that we can review it and notify you if something is missing.  Failure to complete this information may limit your ability to register for future coursework or view your transcript.

You should return the completed forms using one of the following three options: 

TO AVOID DELAYS WHEN YOU ARRIVE, BRING A COPY OF EVERYTHING YOU SUBMITTED TO KUTZTOWN UNIVERSITY WITH YOU TO CAMPUS.

DO NOT MAIL ANY ORIGINAL DOCUMENTS; WE WILL ACCEPT COPIES.

  1. KUTZTOWN UNIVERSITY WILL PAY THE RETURN SHIPPING FEE
    1. DO NOT THROW AWAY THE UPS ENVELOPE PLACE THE COMPLETED DOCUMENTS IN THE UPS ENVELOPE.
    2. PLACE THE ENCLOSED UPS RETURN LABEL OVER THE EXISTING LABEL ON THE FRONT OF THE UPS ENVELOPE AND RESEAL IT.
    3. TAKE THE ENVELOPE TO YOUR NEAREST UPS STORE OR DROP BOX. YOU WILL NOT BE CHARGED ANY RETURN SHIPPING FEES. WE WILL RECEIVE YOUR SHIPMENT IN APPROXIMATELY 2 DAYS.
  2. STUDENT WILL PAY THE RETURN SHIPPING
    1. TAKE THE COMPLETED DOCUMENTS TO YOUR LOCAL POST OFFICE. YOU WILL BE RESPONSIBLE TO PAY THE RETURN SHIPPING FEES.
    2. PLEASE MAKE SURE THAT THE SHIPPING METHOD YOU CHOOSE GUARANTEES 
    3. THAT YOUR INFORMATION WILL ARRIVE TWO WEEKS PRIOR TO THE START OF THE SEMESTER. MAIL TO:

      KUTZTOWN UNIVERSITY
      HEALTH AND WELLNESS CENTER
      PO BOX 730
      KUTZTOWN, PA 19530
      UNITED STATES
  3. SCANNED AND EMAILED - STUDENTS SHOULD USE THEIR UNIERSITY EMAIL ACCOUNT AND REQUEST A 'READ RECEIPT' FOR PERSONAL CONFIRMATION THAT WE HAVE RECEIVED THE INFORMATION.


The same information must be entered in the following electronic forms through the Required Medical Forms button below: 

  • Electronic Health History form
  • Electronic Insurance form (only if you are insured)
  • Electronic Notice of Privacy Practices form
  • Electronic Permission for Treatment Agreement (18 years or older) OR Consent for Treatment of a Minor (parent/guardian must download, print and submit)
  • Electronic Options for Meningitis Compliance (required for resident students) OR Options for Meningitis Compliance for a Minor (parent/guardian must download, print and submit)
  • Electronic Vaccine History form (see below for details)
  • The following diseases will require proof of immunity by vaccine, titer, or physician-documented illness: Rubeola (Measles), Mumps, Rubella (German Measles), Hepatitis B, and Chickenpox. A tetanus vaccine within the past 10 years also is required. Students in high-risk countries for tuberculosis will be asked to complete a screening questionnaire and submit documentation of a normal chest x-ray or a negative skin test. Students who are missing immunizations will be required to obtain the necessary vaccines at their own expense through Clinical Services.

Click on the link to access the portal where the forms reside. You will need to enter your university network username, password and date of birth. If you cannot locate or remember this information, contact the IT Help Desk at 610-683-1511.