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Medical and Mental Health History Form

  • All students participating in an off-campus program lasting at least two nights are required to accurately complete this form.  A parent must sign as well if the student is under 18 years of age.
  • A photocopy of the front and back of all major medical cards from each participating student is also required.
  • Advise students to purchase the International Study ID card or iNext Travel Card for international programs.  These cards include medical insurance that is valid worldwide.
  • These forms should be carefully reviewed with the individual students prior to leaving for the trip.
  • Students who have signed an immunization waiver with the Health Center will not be allowed to participate on Hope-sponsored international trips. Have the student contact the Health Center before any deposit is paid!
  • The program leader should take the original forms along on the program.  Copies of the forms should be left with the department secretary in a sealed envelope – this is confidential information!

Click here for the form.