Medical Information SSLP 2019

The following forms are needed from each participant in the Sea, Science, and Leadership Program.  The 4th (Medication Administration form) is only required if a participant is on medication.  The first 2 forms will come from your physician.  Item 3 will be a photocopy of your insurance card. 

Please upload the required documentation below.  Please note that all forms are due by June 30, 2019 All forms must be submitted at one time, so be sure to have everything filled out and available at time of upload.  If you cannot upload your documents here, please fax them to us in full at 508-830-5077.  If faxing, please include all documents and a cover page with reference of the student's name and Sea, Science, and Leadership Program.  If emailing, please send to admissions@maritime.edu.  If you have any questions, please reach out to the Massachusetts Maritime Admissions Office at 1-800-544-3411.

***PLEASE NOTE: WE DO NOT ACCEPT PHOTOS OF THE DOCUMENTS.

Printable Checklist of Needed Items

  1. Most Recent Physical Documentation (get from physician)
  2. Immunization Records (get from physician)
  3. Copy of Valid Health Insurance Card (front and back)
  4. Student Health Form (physician's signature required)
  5. Medical Administration Form
  6. Emergency Care Consent Form
  7. Parental/Guardian Questionaire
  8. Code of Conduct
  9. Permission to Release
  10. Image Release Form
  11. MA Sports League Waiver Form
  12. Sunscreen Policy

 

Upload Here