Forms

These forms may be downloaded and printed on your printer for completion.

Note, you will need to have Adobe Acrobat Reader installed on your computer to access these forms.

If you need a copy of your medical records, please fill out and return the form below.

Medical Records Release Form

You may fax your records release to 970-351-2427

To Parents: If you student is under the age of 18, you will need to provide a signed Consent to Treat Form prior to your student seeking care at the Student Health Center Medical Clinic located in Cassidy Hall. Please choose the link below to download this form.

Consent to Treat / Emergency Contact Information

Immunization Requirements: Per the State of Colorado Immunization requirements, all University students are required to show proof of two MMR (measles, mumps, and rubella) vaccines. Please submit your Immunization record to:

Student Health Services/ Immunizations Office
Campus Box 46
Greeley, CO 80639
970-351-1919

email to: debra.miller@unco.edu

Fax to: 970-351-3234 or 970-351-2427

If you need a Certificate of Immunization to take to your physician, you can find this form by choosing the link below.

Certificate of Immunization Form

If it has been more than 3 years since your last Meningitis booster, the CDC recommends a booster dose for all University students. You can obtain this vaccine free in the Student Health Center Medical Clinic located in Cassidy Hall.

Insurance Requirements:

All Undergraduate students taking 9 or more credits and all Graduate students taking 6 or more credits, are required to show proof of health insurance coverage. If you have current coverage, you may waive the school insurance fee. To waive the UNC insurance program, see instructions below.

NOTE: The Insurance Waiver for Fall 2014 will be available May 11, 2014 through your URSA account. Waivers MUST be completed through the online process. The Insurance Office no longer needs a copy of your insurance card.

If you do not waive the UNC Sponsored Plan, you will be billed $1100.00 for Fall semester and again for Spring semester 2015.

Instructions for Accessing the Online Waiver Form:

  1. If you already have an URSA account, you may log into http://ursa.unco.edu, click on the Financial tab and locate the link to the "UNC Student Health Insurance Plan Online Waiver System" (SHIP). Important: Please be sure to have your insurance card available before you enter the online waiver system!
  2. If you have been admitted, but do not have an URSA account, access the URSA home page at http://ursa.unco.edu and create your student account from the link titled "New Students Start Here." Once your account has been established, follow the same steps as in item 1 above.

The deadline to waive participation in the UNC-Sponsored Plan for Fall and Spring Semesters 2014-2015 is September 8, 2014.

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