Health History Immunization & Physical Form

Virginia State law (code 23-7.5) requires all students to submit a completed Health History and Immunization record. All students must have primary insurance coverage through their own insurance provider OR accept the policy offered by Averett University. Please see information attached in regards to AU insurance.

Dear AU Cougar:

Averett University would like to take this opportunity to welcome you to AU. We look forward to an exciting year. We understand that this is a busy time for new and returning college students; however, the following Health Form paperwork must be completed before the school year begins. Please schedule an appointment with your doctor for your admission health evaluation and/or your athletic physical soon.

All full-time students, as well as any student eligible for services, are responsible for returning your Health Evaluation Form to AU. This form will not be accepted if the physician completing and signing the form is a family member.

Previously enrolled students, who are reentering as full-time students, after an absence from campus of greater than 2 years must update their health form to meet current standards. If the absence is greater than 6 years, the entire form requires resubmission.

For those seeking religious exemption, a Certificate of Religious Exemption (Form CRE-1) is the only form accepted.

Omission or misrepresentation of pertinent medical information is a violation of the honor system.

FAILURE TO COMPLETE THIS REQUIREMENT WILL RESULT IN A “HOLD” BEING APPLIED TO YOUR ACCOUNT AS WELL AS LATE FEES OF $100 ON AUGUST 30 FOR SUMMER/FALL ADMISSION OR ON JANUARY 17 FOR SPRING ADMISSION.

ALL STUDENTS at Averett University must complete the Health Form. Mail these documents to the Assistant Dean of Students and maintain a copy for your personal records. *Attach a copy of the front and back of insurance card*

ALL STUDENT ATHLETES at Averett University must complete athletic physical and mail them to the Department of Athletics.

The deadline for return for the Fall Semester is August 30, 2019.

Mail health form and immunizations to:

Averett University
Jill Adams
Assistant Dean of Students
Title IX Coordinator
420 West Main Street
Danville, VA 24541

Mail Athletic Physical forms to:

Averett University
Thomas Underwood
Head Athletic
420 West Main Street
Danville, VA 24541

Thank you,

Jill Adams
Assistant Dean of Students
Title IX Coordinator
Averett University
434-791-5628
jadams@averett.edu