New Students
Forms, guides, and instructions new students need to meet student health requirements and submit immunization documentation.
Forms
- Pre-Registration Immunization Form
- Columbia Health and Related Services Enrollment Form
- Student Health History Form
- Religious Exemption Request Form: MMR Immunization
- Medical Exemption Request Form: MMR Immunization
- Religious Exemption Recertification Request Form: MMR Immunization
- Notice of Privacy Practices: HIPAA and FERPA
- Notice of Privacy Practices Acknowledgement
Current Students
Forms, guidelines, and instructions for students eligible to receive services from Columbia Health.
Forms
- Columbia Health and Related Services Enrollment Form
- Non-Formulary Medication Administration Form
- Allergen Immunotherapy Administration Form
- Consent for Treatment at CPS (including Telecounseling)
- Consent for Administrative Evaluation (CPS)
- Student ADHD Questionnaire
- Authorization for the Release of Health Information (Medical Services and CPS)
- Acknowledgement of Receipt of Records (CPS)
- Authorization for Release of Records (SVR)
- Authorization for Treatment of Minors
- NYS Department of Health Authorization for Release of Health Information
- Information on Advance Directives
- Notice of Privacy Practices: HIPAA and FERPA
- Notice of Privacy Practices Acknowledgement
Health Insurance
Forms and information for students enrolled in the Columbia Student Health Insurance Plan (Aetna Open Choice PPO).
Guides
- How to Enroll in the Columbia Student Health Insurance Plan
- How to Request a Waiver from the Columbia Student Health Insurance Plan
- Waiver Eligibility Checklist
- How to Enroll Dependents During the Enrollment Periods
- How to Enroll in Voluntary Dental/Vision Insurance Plans
- The Columbia Plan Compared to a Platinum Plan on the Insurance Exchange
- Student Insurance Key Information
- How to Use the Columbia Student Health Insurance Plan
- The Columbia Plan Benefit Grid
- No-Cost Drug List for the Columbia Plan
- Dental Discounts for Columbia Plan Holders
- Vision Discounts for Columbia Plan Holders
- How to Submit a Claim for Reimbursement from Aetna Student Health
- Lab tests ordered by an off-campus specialist
- Coverage while Traveling
- Aetna Student Health Contact Information
Students with Disabilities
Forms and guidelines for students who wish to register or are currently registered with Disability Services and wish to access accommodations.
Guides
- An Overview of Resources and Perspectives for Students with Disabilities at Columbia (video)
- How to Register for Academic and Campus Accommodations
- General Guidelines For Disability Documentation
- Guidelines for Documentation of Attention Deficit/Hyperactivity (AD/HD) Disorder
- Guidelines for Documentation of Learning Disabilities
- Guidelines for Documentation of Psychiatric Disabilities
- Guidelines for Service and Assistance Animals
- Guidelines for Sensory Disability Documentation
- Workshops for Students with Disabilities
- Disability Access Map
- Disability Policy On Confidentiality
- Disability Services Liaisons
Forms
- Disability Registration Form
- Registration for Students Not Diagnosed With Disability
- Accommodation Letter Request Form
- Testing Accommodation Request
- Quiz Accommodation Request
- Final Exam Accommodation Request Form
- Disability Verification Form for Concussions
- Verification of Disability Form for Mental Health Treatment Providers
- Request for Sign Language Interpreting Services
- Request for Note-Taking Services
- Request Housing Accommodation for CC & SEAS
- Request Housing Accommodation CUIMC
- Request Housing Accommodation GS & Graduate
- Request for Supplemental Accommodation
- Request for Foreign Language Substitution
- Request for Speech-to-Text Services
- Service Animal Registration Form
- Verification of Disability Form for Medical Providers
- Verification of Disability Form for Asthma and Allergy Conditions
- Authorization for Release of Records (Disability Services)
- Venue Accessibility Survey
Faculty and Staff
Information and request forms for faculty and staff on working with Columbia Health to support students.
Guides
- Resources for Faculty and Staff
- Disability in the Workplace
- Disability Services Liaisons
- Faculty Guide for Disability Services
- University and Affiliate Referrals for Disability Concerns
- Guidance for Faculty and Staff Supporting Students in Distress
- Mental Health Outreach
- Using Inclusive Teaching Principles in the Classroom
- Guide to Effectively Referring Students to Columbia Health
Forms
- Graduate Exam Proctor Requests
- New Student Orientation Request
- SVR New Student Orientation Request for Undergraduate Schools
- SVR New Student Orientation Request for Graduate Schools
- Request a Workshop or Training for Students
- Request a Workshop or Training about Sexual Violence
- CPR Training Request Form for Student Groups, Faculty, and Staff
Other Forms and Documents
Additional documents related to student health.