Medical Application Form

Please note: This form is only for international student applicants. If you are a returning resident, please download the appropriate form off the fees and applications page.

 

General Information

Please include area code

All information in this form is confidential.

***Note: You DO NOT need your doctor to fill out this form. If you have any questions please contact Shannon Loewen, Residence Director.
Emergency Contact Information
Please provide dates of most recent immunizations

In order to complete the medical form you must have a recent tuberculosis(TB) skin test performed. Please record the result and date of the test below. If you have not yet completed a TB skin test, you can email the result to Admissions. You cannot be a Tyndale resident unless we have the result of your TB skin test.

Have you ever had the following