2024-2025 Varsity Student Athlete Medical Clearance Form

To be medically cleared for intercollegiate (varsity) sports participation, all incoming first year and new students joining a varsity team are required to have a physical examination within 6 months of the first day of participation for their sport and upload a completed copy the physical examination form.

In addition to the physical examination form, all students must upload a completed Sickle Cell Trait Status form.

For both forms, a physician, physician assistant, registered nurse, or nurse practitioner who is not the student or a relative of the student must complete all questions in English and sign the forms. A copy of these forms can be downloaded here.

Please do not submit this form until you have completed both forms and are prepared to upload them.

Student MIT ID Number*

First_Name*

Last_Name*

DOB*

Phone Number*

Please enter the best phone number to reach you with questions.

Phone

Varsity Sport(s)*

Please select all sports in which you plan to participate.

Select

Date of Physical Exam*

Please enter the date you had your physical examination by a health care provider. This may be different than the date your provider signed your form.

Date of Sickle Cell Test*

Please enter the date of your sickle cell test.

Sickle Cell Test Result*

Negative

Positive

Pending Result

Need to be Tested

File Upload*

Please upload your competed Varsity Student Athlete Physical Examination Form, your completed Sickle Cell Trait Status form and any additional documentation that will assist in your clearance process.

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