Forms and Insurance

Click the button below to view and download the Student Health Form PDF. If you have any questions, please contact Kerry Swierczynski at 267-502-4582.

STUDENT HEALTH FORM

Please be aware of the the following: 

• ANC requires the Student Health Form to be completed every year. Part of this form is the annual physical. This must be dated after May 1st of the year the student is entering. 
   
• All forms are due by August 1st. If a physical can not be done before August 1st, please submit all other forms and note when the physical is scheduled. No student will be allowed on campus, including sports camp, until ALL forms are completed. 
   
• The State of Pennsylvania requires the submission of vaccine records yearly. Please provide updated records or vaccine exemption.
   
• ANC recommends all students be covered by a comprehensive health insurance plan that can be used in Pennsylvania. Please note that other state-specific Medicaid will not pay for care in Pennsylvania.  
   
• All international students must purchase US insurance through ANC. Please contact the Doering Clinic for information.