Varsity Athletes

Welcome Varsity Athlete,

As your health and safety are of the utmost importance you must receive medical clearance from our office, CCSU’s Student Health Services at the Student Wellness Center, prior to participating in our varsity athletic program.  Our medical clearance process requires you to complete the following five steps:

1. Completion of the Connecticut State University Student Health Services’ Form (Grey)
2. Completion of the CCSU Varsity Athletics: Supplemental Student Health Services’ Form (Blue)
3. Submission of results of testing for sickle cell trait or a signed waiver opting out of the testing (Pink)
4. Email medical forms and all required documentation to sws@ccsu.edu as a PDF attachment only.
5. An appointment with CCSU Student Health Services for University Clearance after your Sports Physical and medical clearance with your physician.

Download Medical Forms

Detailed Instructions for Each of These Steps Are Below:

Step 1: Completion of the Connecticut State University Student Health Services’ Form (Grey)

All students are required to submit a completed Connecticut State University Student Health Services Form prior to matriculating.

On page one you are required to enter the dates of immunization against measles, mumps, rubella (MMR) and varicella (chicken pox) or provide proof of immunity (please attach lab test results if submitting proof of immunity versus actual vaccine dates).

Please note, that all student-athletes must 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). In addition, it is strongly recommended that you consider a Meno B series and annual flu vaccine.

On the first page is a required Tuberculosis (TB) Risk Assessment. Please make sure to answer all questions in section 6. If you answer yes to any question in section 6, you must go to section 6a for further evaluation.

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)

Your sport pre-participation physical exam must be conducted by your primary care provider (PCP) please secure an appointment with their office as soon as possible. Please note that as per NCAA requirements the exam must be done within the last 6 months of the final clearance of your sport by CCSU Student Health Services.

Pages one and two are a health questionnaire that you must complete prior to your sport pre-participation physical examination (PPE) with your PCP. You may need assistance from your parent(s)/guardian(s) to complete this form, as an accurately completed history form is essential to this process.

Page three is the physical examination form, to be completed by your PCP. 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 will call you.

You can avoid delays in being medically cleared to participate in your sport by completing all necessary medical assessments at home and submitting documents to Student Health Services in a timely fashion.

• Your PCP may recommend further testing/labs for any conditions found at the time of your PPE exam. Please make arrangements to have the recommended testing/labs done at home before your anticipated date of arrival. Since many times insurances will not cover out of state providers/and or services, it is important to have all testing done prior to your arrival at CCSU.
• If in the past, you have had any diagnostic tests i.e. cardiac, respiratory, or any other medical workups, then results must be submitted with your forms. Failure to submit these results will delay your medical clearance to participate in your sport.

Step 3: Submission of results of testing for sickle cell trait or a signed waiver opting out of the testing (Pink)

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.

Step 4: SUBMITTING YOUR MEDICAL FORMS and all pertinent health information.

• When all of your forms (Grey, Blue, and Pink) are complete, please save them in ONE PDF file with your name and sport (example: JohnSmith_MSoccer.pdf or JaneSmith_WSoccer )
• Be Advised that CCSU Student Health Services will only accept your medical documents in a PDF format.
• Please e-mail medical forms and all pertinent health information to sws@ccsu.eduas a PDF attachment only.
• Please retain a copy of all forms for your own records

DO NOT email, fax, mail or give medical health forms to coaches to submit for you. Your coaches should not request or be provided with copies of any of your personal medical health forms. It is your responsibility to submit these medical forms directly to CCSU Student Health Services.

We are very happy you are joining us at Central Connecticut State University. All of us in Student Health Services are here to help you succeed in your academic and athletic career at CCSU. Please contact us at 860-832-1925 if you have questions or require special considerations.

Wishing you a healthy, successful, and safe varsity season.

Dr. Marisol Ostrov, APRN, Ed.D.
Central Connecticut State University
Student Health Services