New Student Health Forms

Step One: Read the New Student Vermont Immunization Requirement Notice

• All Middlebury College undergraduate students must comply with Vermont’s immunization law.
• Obtain and review your immunization record with your healthcare provider ASAP.
• Compare the Vermont immunization requirements with your personal immunization record. Make an appointment to receive missing immunizations over the summer.
• Submit your immunization record via the Student Health Portal NOW. If you are missing immunizations, you must also submit/upload a Request for Provisional Admittance. This form is provided in Step Two.
• Do not wait until you have a physical. Delays in getting immunization information to Middlebury over the summer could lead to class registration and dorm room access being held. Failure to submit these forms will result in exclusion from campus.
• Provisional admittance and religious or medical exemptions exist; however, students who are not immunized will be asked to leave campus for an extended period of time in the event of a disease outbreak.
• Acting early and carefully following the instructions will avoid delays and inconvenience on arrival day and/or possible exclusion from campus.

Step Two: First-Year Health Documents

Print your First-Year Health Documents:

• Immunizations Required by Vermont Law-reference to share with your health care provider
• Request for Provisional Admittance-to be completed IF a student is not in compliance by the submission deadline of June 15th
• New Student Attestation and Consent Form-to be completed by all and uploaded
• Physician TB Form-to be used IF a student is at risk for TB (see online form)

Print the Physical Examination Form

• Must have physical within 6 months of start date for all students participating in intercollegiate sports, club rugby or crew
• Recommended, but not required for all other Middlebury students

Step Three: Student Health Portal

Log into the Student Health Portal.

Register for the student health portal using your username@middlebury.edu address. Enter your password for your Middlebury account and your multi-factor authentication (MFA) challenge, if prompted.

Step Four: Online Forms

In the Student Health Portal, select My Forms. Read all instructions and complete/submit all forms that are listed. When submitted, they will disappear from the list.

• Health History Form: Required for all students. Please print a copy before you submit it and bring this copy to your healthcare provider to review when you have your physical.
• TB Screening: Required of all students.
• Other Forms: Follow all instructions.

Step Five: Health Documents

Please upload the following documents as instructed:

Immunization Record

• Have your healthcare provider review the Immunizations Required by Vermont Law (page 1 of FIRST-YEAR HEALTH DOCUMENTS you printed). **You must be in compliance with Vermont law. Some states/countries have different requirements. Ask your healthcare provider to ensure that your immunization record meets the Vermont requirements prior to uploading. If you require additional immunizations, your healthcare provider must complete the Request for Provisional Admittance form. Upload this with your immunization record as one upload. DO THIS NOW. DO NOT WAIT.

• To upload an image of your immunization record, select Document Type, then Immunization Record, then Save.

Healthcare Provider Form

• If you are an incoming athlete, please follow First-Time Athletic Participant Clearance Procedures for your directions and disregard the healthcare provider form in the first-year documents. A physical exam is required within six months of starting the sport for intercollegiate NCAA athletes, including club rugby and crew.

• Schedule an appointment with your healthcare provider for a physical. A physical exam is required within six months of starting the sport for intercollegiate NCAA athletes, including club rugby and crew. Physicals are strongly recommended for all other students.

• Have your healthcare provider complete, sign, and date the Healthcare Provider Form (part of the three-page First-Year Health Documents).

• To upload the Healthcare Provider Form, select Document Type, then Healthcare Provider Form, then Save.

Physician/Provider TB Form

If you answered YES to any questions on TB Screening from Step Three, you are required to have your provider complete and upload the completed Physician/Provider TB Form (located within the First-Year Health Documents).

• Select Document Type, then Physician/Provider TB Form, then Save.

New Student Consent

This is located within the First-Year Health Documents. Read, sign, and upload this one-page form.

• Select Document Upload, then New Student Consent, then Save.

Insurance Card(s)

• Select Document Upload, then Insurance Card (primary, secondary, or dental), then Save. Please print both sides. 

Step Six: Religious/Medical Exemptions

If you have any religious or medical exemptions, please complete the Vermont College Immunizations Exemptions Form as applicable.

• Select Document Upload, then Immunization Exemption, then Save.
• Please be advised that unvaccinated students may be asked to miss class or leave campus in the event of a communicable disease outbreak.

Step Seven: Troubleshooting

In case there is an error with your uploaded documents, please review our Troubleshooting Tips for Health Portal.

Helpful Links

• Vermont Immunization Statute
• Vermont College Requirements 2022–2023
• Documentation of Varicella Disease