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Providing Health Information and Immunization Information

Except as provided below, all entering students must show a physician validated immunization record for measles, mumps, rubella (MRR) and diphtheria. Applicants from foreign countries are required to present a record of TB skin or IGRA blood test (Quantiferon Gold) completed within six (6) months prior to first enrollment in addition to the above required record of immunization. This evidence must be presented during the first semester the student is enrolled. If either of the tests is positive, a chest x-ray is required. If a student lives in a country which does not offer the TB tests the student must undergo testing upon arrival at the college.

  • A person qualifies for a medical exemption from the requirement to show proof of immunization when the person files a bona fide statement signed by a physician licensed to practice medicine in the United States verifying that the physical condition of the person seeking admission makes the required immunization unsafe and indicating the specific nature and probably duration of the condition. The exemption shall not extend beyond the period which contraindicates immunization. A person qualifying for this exemption must sign a waiver form provided by the college stating that, if an outbreak of measles or rubeola occurs at the college or surrounding community, the person may be subject to exclusion from the campus and college related activities during the outbreak period.
  • A person qualifies for a religious exemption when the person files for a notarized affidavit on an approved form that immunization is contrary to the religious tenets and practices of the signer. A person qualifying for this exemption must also sign a waiver form provided by the college stating that, if an outbreak of measles or rubeola occurs at the college or surrounding community, the person may be subject to exclusion from the campus and college related activities during the outbreak period.
  • A person qualifies for an exemption from the requirement to show proof of immunization when enrolled in off-campus courses or courses offered off-campus by distance learning technology. This exemption will be revoked if, at any time, the student enrolls in on-campus courses. At that time, the student will be required to show proof of immunization during the first semester the student is taking courses on campus.
  • According to guidelines established by the Center for Disease Control and Prevention, a person born before 1957 needs not submit proof of immunization of measles, mumps and rubeola.

Health Forms

Health

Once completed, mail form and immunization records to:
Chadron State College
Attn: Student Health Services
1000 Main Street
Chadron, NE 69337

Forms also may be scanned and emailed to Ms. Anne Dockweiler at: nurse@csc.edu or faxed to 308-432-6085. Ms. Dockweiler will communicate with you further for any other requirements

Power or Attorney for Medical Care of Minor Student

(This section only applies to applicants who are over age 18 but under age 19 and does not need to be provided until after the applicant has been accepted for admission to Chadron State College.)

In the State of Nebraska, the legal age of majority is 19. This means that in order for a student who is over the age of 18, but under the age of 19 to be able to consent to his/her own health care and medical treatment, a parent or legal guardian must legally delegate medical consent authority to the minor student. A properly executed Power of Attorney form will allow a parent or legal guardian to legally delegate medical consent authority to a minor student until he/she turns 19.

The parent or legal guardian signature must be notarized by someone authorized by law in the country of their residence to take acknowledgment of official documents. The Power of Attorney will not be valid without a notarized signature.

Return the Power of Attorney for Medical Care of Minor form to the following address and keep a copy for your own records:

Chadron State College Health Services
1000 Main Street
Chadron, NE 69337

Power of Attorney for Medical Care of Minor Form

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