Student Health Forms

All Commuter and Resident forms can be located by logging into the secure health portal at:  


You will need your Molloy email and password to log into the secure Molloy Health Portal to submit the required documents. 

Required Immunization  Commuter Student  Resident Student 
MMR (2 measles, 1 mumps, 1 rubella) 
Current Physical & Health History   
Meningococcal ACWY within the last five years OR proof of a complete 2-3 dose Meningitis B series  ✔  (May be waived by completing Meningitis Response question)  ✔ 
Tuberculosis Screening Questionnaire (International Students MUST have a Tuberculosis Screening Test)   

For Resident and International Students Only:

  • Current physical exam must be within the last 12 months (Downloadable Physical Evaluation form located in the secure Molloy Health portal or Explore section of this page.)   
  • International Students are required to upload a current Tuberculosis screening test within the last 6 months. 

All students under 18 years of age: please have a parent or guardian fill out the Minor Parental Guardian Consent form and upload the completed form to the secure health portal under Document Upload. (Downloadable form located in the secure Molloy Health portal or Explore section of this page.) 


Molloy By the numbers


Money magazine's # 1”Value All-Star” in the nation

comprehensive degree-granting institution


Molloy’s undergraduate student-faculty ratio

means our students are key


Our tuition is 15% lower than other

private, 4-year colleges on L.I.


Of seniors participate in a co-op, practicum

clinical assignment or internship

Contact Us

Have questions about anything here? Feel free to drop us a quick note!

Of course, feel free to Contact Us.

Danielle Giovanniello, R.N.
Student Health Services
1000 Hempstead Avenue Wilbur Arts Center Room 103B Rockville Centre, New York 11571-5002

T: 516.323.3467