Dear Varsity Athlete:
As your health and safety are of the utmost importance you must receive medical clearance from our office, University Health Services, prior to participating in our varsity athletic program. Our medical clearance process requires you to complete the following five steps:
- Completion of the Connecticut State University Student Health Services' Form;
- Completion of the CCSU Varsity Athletics: Supplemental Student Health Services' Form;
- Submission of results of testing for sickle cell trait or a signed waiver opting out of the testing;
- Baseline Neuro-cognitive testing (ImPact); and
- Appointment with University Health Services.
Detailed instructions for each of these steps are below.
Step 1: Completion of the Connecticut State University Student Health Services Form (Grey Form)
All matriculated students are required to submit a completed Connecticut State University Student Health Services Form. On page one you are required to enter the dates of immunization against measles, mumps, rubella (MMR) and varicella (chicken pox) or to provide proof of immunity (lab test results). Please note, though not required, student-athletes should have up-to-date immunizations against tetanus (within the last ten years and preferably the last seven), meningitis (must be a quadravalent vaccine such as Menactra), and hepatitis B (vaccination against hepatitis A is also recommended). Also on the first page is a required Tuberculosis (TB) Risk Assessment. On page two please provide your past medical and surgical history along with an accurate and complete list of your medications and allergies.
Step 2: Completion of the CCSU Varsity Athletics: Supplemental Student Health Services Form (Blue Form)
Pages one and two are a health questionnaire that you must complete prior to your pre-participation physical examination. Page three is the physical examination form. Your pre-participation physical exam must be conducted either by your primary care provider (PCP). Make sure you complete the health questionnaire prior to your appointment as it must be reviewed and signed by the healthcare provider conducting your physical. You may need assistance from your parent(s)/guardian(s) to complete this form. An accurately completed history form is essential to this process. You cannot receive medical clearance without it.
When your PCP completes your form, please make sure your form is complete and legible. If further testing is recommended or indicated (such as a cardiology evaluation or asthma testing), these results must be attached to the form prior to returning it to us. Please note that we will not accept any other forms or copies of records in lieu of these forms. If any form is incomplete or we have questions, we may call you to schedule a pre-participation exam at University Health Services.
Step 3: Submission of results of testing for sickle cell trait or a signed waiver opting out of the testing (Pink Form)
The NCAA requires that prior to participation in any intercollegiate athletic event (including strength and conditioning sessions, practices, competitions, or try-outs) each new, first-time student athlete must either show proof of a prior test for sickle cell trait, be tested for sickle cell trait, or sign a waiver releasing CCSU of liability if they decline to be tested. CCSU strongly urges you to know your sickle cell trait status. Most states started screening all newborns by 1990. Please contact your primary care provider to get a copy of your newborn screen or to have them order a new sickle cell screening test.
Steps 4 & 5: Baseline Neuro-cognitive testing (ImPact) and Appointment with University Health Services
Once Steps have been completed your paperwork will be reviewed. Please call our office at 860-832-1925, Option 1 to schedule your ImPact testing and sports clearance appointment with one of our providers. You may also be given an appointment to meet with our athletic training staff on the same day. As part of the CCSU Intercollegiate Athletics' Concussion Policy and Procedures, all new student athletes must complete baseline neuro-cognitive testing prior to the first practice. We use a computerized program, ImPact, which measures visual and verbal memory, reaction time and cognitive processing speed. This baseline test is used for comparison if you ever sustain a concussion or head injury.
At your appointment with one of our providers, all the above information will be reviewed. We may repeat parts or all of the physical exam, require further or repeat testing, or even require specialty medical consultation prior to granting medical clearance.
We are very happy you are joining us at CCSU. All of us in University Health Services are here to help you succeed in your academic and athletic career at CCSU.
Wishing you a healthy, successful, and safe varsity season.
Marisol Aponte, APRN
Student Wellness Services - University Health Services