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Providing Health Information and Immunization Information

Please refer to the Immunization Policy for further details.

Health Forms

Health

Once completed, mail form and immunization records to:
Chadron State College
Attn: Student Health Services
1000 Main Street
Chadron, NE 69337

Forms also may be scanned and emailed to Ms. Anne Dockweiler at: nurse@csc.edu or faxed to 308-432-6085. Ms. Dockweiler will communicate with you further for any other requirements

Power or Attorney for Medical Care of Minor Student

(This section only applies to applicants who are over age 18 but under age 19 and does not need to be provided until after the applicant has been accepted for admission to Chadron State College.)

In the State of Nebraska, the legal age of majority is 19. This means that in order for a student who is over the age of 18, but under the age of 19 to be able to consent to his/her own health care and medical treatment, a parent or legal guardian must legally delegate medical consent authority to the minor student. A properly executed Power of Attorney form will allow a parent or legal guardian to legally delegate medical consent authority to a minor student until he/she turns 19.

The parent or legal guardian signature must be notarized by someone authorized by law in the country of their residence to take acknowledgment of official documents. The Power of Attorney will not be valid without a notarized signature.

Return the Power of Attorney for Medical Care of Minor form to the following address and keep a copy for your own records:

Chadron State College Health Services
1000 Main Street
Chadron, NE 69337

Power of Attorney for Medical Care of Minor Form

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