Fill Out Arrival Form
Fill Out the Meningitis Form
Print and Submit Medical Form
Pay Deposit of $100 to Confirm Your Enrollment
If you have dependent children, read and sign this
Home >  MUM Home >  Admissions >  Accepted Student >  6 Things to Do Before You Travel to MUM >  Print and Submit Medical Form > 
Print and Submit the Medical Form    
The Medical History, including Immunization History must be printed out, completed, signed, and submitted to the campus nurse.

To submit the 2-page form:
  • The form can be faxed to 641-472-1145, or
  • The two pages may be scanned, saved in jpg format, and then emailed as an attached document to the campus nurse, or
  • The forms may also be mailed:
Campus Nurse
1000 N. 4th Mailroom #737
Fairfield, IA 52557

We very much prefer that the forms be sent to us in advance on your arrival on campus, but if necessary they may be submitted at registration.
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