• Apply Now!
Medical Disclosure

Louisiana state law (Act 1047) requires that all persons who are entering Louisiana colleges and universities for the first time and whose date of birth is after 1956, must submit proof of immunization against preventable and/or communicable diseases, including Measles, Mumps, Rubella, and Tetanus-Diphtheria (MMR, Td).

Louisiana state law (Act 251) requires first time freshman to submit proof of immunization against meningitis beginning Fall 2006

Louisiana Tech University requires all new students born after December 31, 1956 to provide proof of immunization against MMR, Td and Meningitis. Failure to complete and return these forms will result in the inability to complete the registration process.

You may download and print the Acrobat Format of the Medical History form here.


Click the Adobe logo to download a free version of Adobe Acrobat Reader!

Download Adobe Acrobat Reader for Free!


This form is to be mailed to:

University Health Center
Louisiana Tech University
P.O. Box 3023
Ruston, LA 71272-0001