Forms

****Healthy For the Holidays FREE Flu Shot and STD Clinic: Information and Forms****

PLEASE BRING A *COPY* OF YOUR INSURANCE CARD AND YOUR STUDENT ID WITH YOU TO THE CLINIC.

Where: University Center South Conference Room

When: Tuesday, November 17th from 4-7pm

What: Flu shot and FREE STD clinic serving all Western student walk-ins provided by Gunnison Public Health.

Minimal paperwork and most insurances accepted.  The below forms should be completed, if possible, and brought with you to the clinic.

Registration Form

Flu Vaccination Form (Flu Shot: $20 donation appreciated for uninsured.  Available to all, with or without insurance. FluMist: available only to those with insurance or for a fee of $25.)

STD Testing Form (FREE)

Required Forms

State and Federal law require that Western receive immunization records for all full-time students.  In addition, certification of registration with Selective Service is required for all males over the age of 18.  For more information on both topics and their required form, please see the below links:

 Additional Forms