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Request Student Health Records Form - Becker College 2026

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The document is a Medical Records Release Authorization form from Becker College Health Services, allowing individuals to authorize the release or request of their medical records, including immunization records, lab reports, and physical exams. It requires personal information, specifies the purpose of the request, and includes signature lines for the student and parent/guardian if applicable.

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Click ‘Get Form’ to open the Request Student Health Records Form in the editor.
Begin by entering your name and date of birth in the designated fields at the top of the form. This information is essential for identifying your records.
Fill in your address, including city, state, and zip code. Accurate contact details ensure that any correspondence regarding your health records reaches you promptly.
Provide both your home and work phone numbers. This allows Becker College Health Services to reach you if there are any questions about your request.
Indicate whether you authorize Becker College to release information to another party or request information from another source by checking the appropriate boxes.
Specify which medical records you wish to request or release by checking the relevant options such as Immunization Records, Lab Reports, Physical Exam, or Complete Record.
State the purpose of this authorization clearly in the provided space. This helps clarify why you need access to these records.
Finally, sign and date the form. If you are under 18 years old, a parent or guardian must also sign. Ensure a witness signs as well if required.

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What is Becker College known for?

Becker College will become nationally recognized as an innovative, creative institution renowned for its focus on delivering to the world highly educated students with the ability and agile mindset to be entrepreneurial, socially responsible global citizens who are able to navigate the complexities of a rapidly

Is Becker College accredited?

Officially accredited by the New England Commission of Higher Education, Becker College (BC) is a small (uniRank enrollment range: 2,000-2,999 students) coeducational US higher education institution.

What is the average tuition for Becker College?

The median undergraduate tuition at Becker College is $36,300, which is $7,795 more than the national average for Baccalaureate Colleges ($28,505).

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What will happen to Becker College campus?

The school is renting the former Becker College building from the city, which purchased the building when Becker permanently closed. After Becker College closed in the fall of 2021, the city of Worcester and a local developer bought the properties that made up the small liberal arts school.

How do you know if a College or university is accredited?

To determine the accreditation status of any college or university, the Commission uses a publication entitled Accredited Institutions of Postsecondary Education (AIPE) to verify accreditation. To obtain a copy, please visit the AIPE website at .acenet.edu.

Request Student Health Records Form - Becker College 2026

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