Incoming forms for Graduate Students

These requirements apply to Graduate students in the MAT Licensure program.

We strongly encourage you to receive the annual flu vaccine.

The My Health Connection portal must be used to complete the required health forms. Your user name and password for the portal is the same to access my.mtholyoke. Below is a list of all forms that you must complete.

All online forms including:

  • Immunization Records: After entering the dates online, you will need to submit a verified copy of your immunization record which includes: COVID-19 vaccination, 2 doses of MMR vaccine, 2 doses of varicella vaccine, 3 doses of Hepatitis B vaccine, one dose of meningitis vaccine within the past 5 years, one dose of Tdap vaccine. Please view the instructions. Submit a copy from your physician's office for verification.
  • Tuberculosis Screening Form: TB Testing Form may be required. This is located within the Downloadable Forms Section

**Physical Forms are not required

Vaccination exemption forms (if applicable)

Required forms can be sent via Email: medical-records@mtholyoke.edu or Fax: (413) 538-2352