Does anyone in your immediate family have these health issues? If so, please provide the relationship of the person.
The Office of Academic Support will need documentation of disability on items 4 and 5 that verifies eligibility for services requested.
Please have your doctor or primary care physician email your immunization records to us at firstname.lastname@example.org.
Alternatively, you or your doctor can mail them to:
Mount Vernon Nazarene University
800 Martinsburg Road, Mt. Vernon, OH 43050
By completing this form, and signing it below, I agree to each of the following.