Health Form

Resident students must complete this medical form with the assistance of a physician prior to arrival at LVC. LVC requires the following immunizations (listed on the form):

  • TDAP/Adacel/Boostrix (circle)
  • OPV (polio) series
  • MMR
  • Varivax vaccine or Varicella Disease
  • Meningococcal (Menactra (A/C/Y/W-135)
  • Tuberculosis Testing (PPD) within the past 12 months

The LVC Health Center only offers a meningitis vaccine on-site for a cost of $125. Other immunizations will have to be secured off-site for additional fees.

The following immunizations are recommended, but not required:

  • Hepatitis A
  • Hepatitis B
  • HPV


Additional Forms

If you have any of the following conditions, please take the time to fill out the form(s) that is most relevant for you:


Health Insurance Coverage

Lebanon Valley College requires all residential international students to maintain medical insurance that provides coverage in the United States. Therefore, enrollment in the Lebanon Valley College sponsored health insurance plan is automatic and the cost of the policy is included in the student’s tuition and fees invoice. In certain cases, students holding comparable insurance policy coverage may be eligible to waive enrollment in the LVC's health insurance plan. In addition to personal health insurance coverage, the comparable plan must include the following benefits and minimum limits in order to be considered for an exemption:

International Students Attending Classes at Lebanon Valley College
Emergency Accident
& Sickness
$100,000 Can be included in personal health insurance if coverage extends to care in the United States.
Medical Evacuation $250,000  
Repatriation $50,000  


Additionally, students will provide evidence that the comparable policy has a health insurance claims office based in the United States. Students requesting a waiver review of their individual insurance policy should submit the following information to international@lvc.edu by Aug. 1 for fall semester and Dec. 1 for spring semester:

  • Insurance company name
  • Insurance company phone number and claims address
  • Policy number
  • Policy holder name and date of birth
  • Photocopy of policy holder ID (if already purchased)
  • Detailed list of coverage benefits

After review and acceptance of your submitted waiver form, your Lebanon Valley College tuition invoice will be credited the automatic policy premium. Please note that the waiver request must be renewed every academic year.