Student Accommodation at UMass Lowell

Student Accommodation at UMass Lowell
Preparing for
your Navitas
FALL 2015
Navitas at UMass Lowell
Table of Contents:
Letter from Executive Director………………………………………………………………………. 3
About Lowell/UMass Lowell……………………………………………………………………….…..4
On-campus Accommodations……………………………………………………………………….…5
Orientation Information………………………………………………………………………………...7
Immigration Information…………………………………………………………………………….…8
Traveling to the United States………………………………………………………………………..9
Adjusting to life at UMass Lowell…………………………………………………………….…….10
Monetary Information………………………………………………………………………….………11
Packing List………………………………………………………………………………………………..12
Frequently Asked Questions…………………………………………………………….……………14
Airport pick up form………………………………………………………………………………….…15
Student Accommodation at UMass Lowell………………………………………………………16
Off-Campus Housing at UMass Lowell…………………………………………………………...20
Fall Housing Registration……………………………..……………………….…………….……….21
Health Forms………………………………………………………………………………………..…….24
Navitas at UMass Lowell
Dear Incoming Navitas Student,
Congratulations on your admission to Navitas at UMass Lowell. You have chosen to
attend a premiere university in the United States which is nationally recognized for
its research and academic programs. I am sure that you will be delighted with your
decision to earn your degree here.
At Navitas at UMass Lowell, you will be taught by some of the best college
professors in the United States. You will be located on a dynamic campus along the
Merrimack River, with access to all the recreation and social opportunities available
on campus, throughout the historic city of Lowell, and across New England.
The caring staff at Navitas at UMass Lowell is aware of the mixed feelings of
excitement and anxiety that you must be experiencing now, and will experience as
you settle in here. Our staff will provide you with a warm welcome and will continue
to support you in your adjustment to life in both an American University and in
magnificent Lowell.
Please stay in touch with us over the next few weeks. We will be sending you
information to make your arrival and stay as easy and pleasurable as possible.
Please do not hesitate to ask us any questions that you might have.
When you get your VISA, feel free to make your travel arrangements. If you
require an airport pick up, please contact our admissions office with the details so
that we can arrange for someone to meet you and bring you to campus.
Once again, congratulations and welcome to our Navitas family. We are so pleased
that you are joining us here at Navitas UMass Lowell and really look forward to
meeting you soon.
Ellen J. O’Brien, Ed.D.
Executive Director
Navitas at UMass Lowell
Navitas at UMass Lowell
Studying and learning with Navitas at UMass Lowell
At Navitas at UMass Lowell we understand that the transition to university-level
study can be difficult. To assist you in developing the study skills necessary to
successfully complete your program, Navitas and UMass Lowell offer a variety of
support services.
In your Navitas Program, you will take a full-time schedule, typically five courses
per semester and any required laboratories. All Navitas instructors will have office
hours where they can meet with you and address any concerns you have about
your progress in the course. The small class size and specialized instruction will
help you improve your skills. Meetings with academic advisors will happen
throughout the semester as well.
Student Involvement
The university has over 100 clubs and organizations. Groups such as the Biology
Club, Math Club, Society of Environmental Scientists, Indian Student Association,
Association of Students of African Origin, International Student Organization,
Cambodian American Student Association, Christian Student Fellowship, Latin
American Student Association, Middle Eastern Student Association, Vietnamese
Student Association, and French Club to name a few. Or join their Ballroom
Dancing Club and partake in their annual Dancing with the UML Stars competition.
Starting an Undergraduate or Graduate Club is an easy process. If there is
currently no club or organization that matches your interest, you may consider
organizing a new one.
All about the City of Lowell
State: Massachusetts
Population: 105,167
Area: 14.54 Square Miles
Currency: United States Dollar
Time Zone: Eastern Standard Time
Electricity: 120V
Languages: English
Religions: Over 40 religious groups including Catholic, Protestant (Baptist,
Methodist, Episcopal), Muslim, Jewish, Buddhist, Hindu, Greek Orthodox, and more.
Lowell has a wonderfully diverse climate with warm summers, cold winters and a
mild spring and fall. The unpredictable weather which can change very quickly is
often a topic of polite conversation. The average low temperature is around 24°F
(-4°C) and highest is around 85°F (29°C) over the year.
Navitas at UMass Lowell
Things to do:
Boating, hiking, skiing, ice hockey, golf, soccer, biking, white water rafting, whale
watching, live music concerts, Lowell Spinners Baseball games, visiting art galleries,
and eight free festivals a year.
Attractions in the surrounding area:
Boston’s historic Freedom Trail, Fenway Park (home to the Boston Red Sox), the
White Mountains, beaches, ski resorts, and Cape Cod.
On-campus accommodations
UMass Lowell guarantees you on-campus housing as a Navitas at UMass Lowell
student provided your forms are completed by the deadline. In addition to a higher
degree of academic success, students who live on campus tend to have a greater
connection to the university, are more involved with the community, and take
greater advantage of the services and extra-curricular activities available. There are
also the special friendships and bonds you will make by living in on-campus
All of the residence halls offer amenities and features that will help you stay
focused on academics. The residence halls are only a short walk from the
classroom buildings, dining halls, Tsongas Center, LeLacheur Baseball Park, Campus
Recreation Center, the University Library and more. Each room includes a bed,
dresser, desk, chair, and wardrobe. Rooms are wired for high-speed internet
access, standard cable television, and for local and on campus calling; however,
you must purchase your own phone and television. Many of the residence halls
have common TV rooms, common laundry facilities and vending machine areas.
Fox Hall has common kitchens that you may use if you would like to prepare your
own meals.
Academic Facilities
Students who live on campus have the opportunity to spend more time in the
academic rooms, computer rooms, libraries and the Centers for Learning and
Academic Support Services (CLASS).
Campus Dining
Campus dining at UMass Lowell is varied and distinctive. There are eight locations
to choose from, including 3 dining halls and 2 restaurants, which offer everything
from made to order dinners, salad bars, grill, deli and fast food options. The meal
plan will cover meals each day for the entire week of the semester. Between
semesters, special arrangements will be made.
Students under the age of 18
Enrolled students under the age of 18 are allowed to live on campus. All students
under the age of 18 must have a parent or legal guardian sign the housing contract
as well as the health form allowing medical treatment for students.
Navitas at UMass Lowell
Shuttle bus
The university shuttle bus will transport you around campus seven days a week.
Any activity the university has to offer is only a quick shuttle trip away. Most
buildings can be accessed by walking.
Airport pickup
We provide transportation from Boston Logan International Airport to UMass Lowell
residence halls. To request pick up upon arrival to Boston Logan International
Airport, please fill out the form online through the link given at the back of this
packet send it to [email protected] at least one week before
Navitas at UMass Lowell
Orientation and Arrival to the United States
Before the start of the semester, Navitas and UMass Lowell offer an orientation
program to help you prepare for the semester. At orientation you will learn all you
need to know about life at UMass Lowell. You will tour the campus, meet the staff
of the International Students and Scholars office, set up a U.S. bank account and
prepare to start the semester.
Move-in and Check-in day: August 25th, 2015
Orientation will begin morning of: August 26th, 2015
If the weather conditions are severe, the University will be closed. In this case, the
Check-in day will be moved to the following day. Please make sure to arrange
accommodation for the night appropriately.
If you would like to arrive in Lowell prior to the start of orientation, you will need to
make arrangements for where to stay prior to moving into the residency.
The Inn and Conference Center at UMass Lowell offers special discounts for UMass
Lowell international students like you. In order to make a reservation, please visit You will need to pay
for your stay by credit card up on arrival.
The Radisson Hotel & Suites Chelmsford-Lowell is a short distance from campus
offering free shuttle service to UMass Lowell. In order to make a reservation, please
visit You will need
to pay for your stay by credit card up on arrival.
If you plan on traveling within the United States before the start of classes plan on
arriving into the U.S. early and arriving in Lowell on time for orientation.
Navitas at UMass Lowell
Applying for your F-1 Student Visa
It is necessary for non-U.S. citizens to have visas to enter the United States. To
study in your Navitas at UMass Lowell program, you will need to apply for an F-1
Visa applications are made at U. S. consulates or consular sections of U.S.
embassies closest to an individual's place of residence. To apply for a visa you must
A valid passport OR acceptable travel document
Proof that you are the person identified by the passport
Required photographs (please follow the embassy or consulates guidelines for
these photos)
Funds for any required fees
Proof of prior education (transcript, diploma, etc.)
A form I-20 (for F-1 visa) or DS-2019 (for J-1 visa) issued by UMass Lowell
Proof of admission to that institution (letter of acceptance)
Proof that you have sufficient funds to study (bank statements or bank letter)
You should be prepared to demonstrate that you have close ties to your home
country and, as you are applying for a non-immigrant visa, that you have full
intention of returning home after you complete your studies.
Navitas at UMass Lowell
Traveling to the United States
Legal Documents to have in your possession:
You may be asked to present all the following at the Port of Entry, so have them
easily accessible in your carry-on along with your Airline Tickets:
Visa Document (Form I-20) - If the U.S. Embassy returned your visa
document in a sealed envelope only to be opened by a U.S. Official at the
U.S. Port of Entry, please honor this
UMass Lowell Admissions letter
The Original Financial Documentation that you provided to U.S. Embassy or
At the Port of Entry, the officer will return Form I-20 to you back. The Official at the
Port of Entry will write “F-1” and “D/S” according to your visa type. Make sure they
do this correctly before walking away. If they did not, politely ask them to do so.
Also refer to the Port of Entry information sent to you by the UMass Lowell
International Students and Scholars Office.
Sometimes Customs and Border Protection agents may not appear friendly. Do not
be nervous, calmly present the documents that the agents requests and answer
any questions they ask you.
Navitas at UMass Lowell
Adjusting to your life at UMass Lowell
Cultural Adjustment
When you start your program at Navitas at UMass Lowell, it will be necessary to
make a cultural adjustment. It is normal to miss your friends, your family and your
home. The Navitas and UMass Lowell community will be here to help you adjust.
Here are some ways you can help yourself culturally adjust to studying here.
Be aware that you may experience some sadness or home sickness when you
are studying with Navitas at UMass Lowell.
Have a tolerance for ambiguity and for differences. Remain open minded,
flexible and adaptable. Try to suspend judgment until you have looked for
the logical reasons behind differences. Be objective and perceptive.
Stay busy. Get involved with activities on the UMass Lowell campus. You may
find that you can continue with the same sports or hobbies you did in your
home country.
Find an American to be a “cultural informant” who will help you gain proper
perspective. Be curious and ask questions about your new surroundings and
the American customs. People will enjoy responding to your interest in
understanding the American culture.
Focus on the positive things about UMass Lowell and living in the U.S.
Keep your self- confidence. Believe you can do it and keep in mind the many
strengths and advantages you will have when you succeed with your studies
in the United States.
Living with a roommate
If you have never lived with a roommate before, there will be an adjustment period
after you first move in. Don’t worry, many American students have never lived with
a roommate before either, and living with a roommate can be a lot of fun.
Here are some hints to living with a roommate:
Be friendly- If you are nice and friendly to your roommate it is likely to be
Be understanding- Try to see the motives behind your roommate’s actions
and help if you can.
Navitas at UMass Lowell
Give your roommate some peace and quiet sometimes- It’s great to have
conversation, however everyone needs time to be alone and of course, to
Do not use your roommate’s belongings- If there is something that you
would like to use, ask!
Keep it clean- Help keep the room clean, no one wants to live in filth.
Talk it out- If you are having a problem with your roommate, talk to them. A
good relationship with your roommate will require some give and take.
Treat you roommate as you wish to be treated- it is as easy as that.
How Much Money to Bring
We recommend that you not carry more than $1000 in cash (the cash should
include small bills.) You may want to keep the cash in two separate areas easily
accessible to you. Be aware of your personal belongings at all times during your
travel. It is unsafe to carry a lot of cash, so please try not to carry more than
We will help you arrange for a bank account in Lowell in your first week so that
money can be wired or deposited.
Your on-campus platinum meal plan provides unlimited access and allow you to eat
what you want, when you want. If you choose to eat off-campus, meals generally
cost $5-10 for breakfast, $5-15 for lunch, and $10-40 for dinner. During certain US
holiday periods, on-campus food choices will be limited.
Navitas at UMass Lowell
What to Pack and What to Purchase upon Your Arrival
Navitas and UMass Lowell will organize a shopping trip after you arrive on campus
and throughout the semester. You will have the opportunity to visit many different
stores. See the list below of what you can purchase upon your arrival.
What to bring with you:
3-10 light shirts or T-shirts
2-4 pairs of pants (either light fabric or 2-3 pairs of jeans)
2-4 pairs of shorts (you may need them in the summer time)
1 jacket or coat (you will need them in the winter time)
5-10 long sleeve shirts or sweaters
1-2 formal outfits (men should bring 1 dress blazer and 1 tie, which could be
purchased here). You may want to bring a traditional formal outfit from your
country for special cultural events.
Shoes can be bought in the U.S. at reasonable prices, but it will be helpful to
bring a pair of sneakers or comfortable shoes, sandals, etc. as well as one
dress pair of shoes.
7-10 pairs of undergarments
1-2 pairs of pajamas
Toiletries - toothbrush, toothpaste, soap, hair brush, deodorant, shampoo,
shaving supplies, feminine protection, etc.
Medication - You will need to carry a doctor’s note for any prescription
medication as you’ll need to present this at airport(s). Follow the
immunization instructional information which was provided to you from the
UMass Lowell Health Services Department. Here is their contact information
in case you have any last minute questions,
Your favorite music or books
Software, computer, educational material- a scientific calculator, a school
bag or back pack. Computers are reasonably priced in the U.S. if you prefer
to purchase one upon your arrival.
Follow this link to learn more about the recommended hardware
configuration and software to you will need at UMass Lowell. There are
computer labs on campus that run Microsoft Office 2007 that you will be
able to use
Electrical Equipment- outlets in the U.S. operate with a voltage of 110-120
volts, 60 cycles. If your equipment requires 220 volts, bring a converter and
plug adapter. If it operates within 110 and 240 volts, bring a plug adaptor.
Navitas at UMass Lowell
Things you can purchase when you arrive:
A warm coat for winter
Any additional clothing
Winter shoes and boots
Bedding (extra long twin sheets, blankets, pillows)
Additional toiletries
Supplies to wash clothes
School Supplies (pens, pencils, etc.)
SIM card and cell phone
Navitas at UMass Lowell
Frequently Asked Questions:
Q: When should I come to the United States?
A: You may enter the U.S. up to thirty days prior to start date found in “section 5”
of your Form I-20, as long as you have a valid F-1 visa. You should make sure you
are in Lowell, Massachusetts by the start date of orientation. Remember, you will
not be able to move into your residency until August 25th, 2015.
Q: Is the water safe to drink?
A: Yes, almost everywhere in the United States has safe drinking water. There are
water fountains all over campus for you to take a drink or fill up a water bottle.
Q: What banking options will I have in Lowell?
A: There is a number of banks to choose from in Lowell, however most students
use Bank of America because of their on-campus ATM locations. During the
orientation you can meet with a Bank of America representative to learn about the
banking options and sign up for an account.
Q: What will I need to do when I arrive?
A: You must attend orientation starting on August 26th, so you may choose to rest
up between the time you arrive and the start of the orientation program.
Q: What can I do if I am home sick?
A: During your orientation you will learn about homesickness and how to deal with
it while you study with Navitas at UMass Lowell. You will also hear about the free
counseling services available to students of UMass Lowell.
Navitas at UMass Lowell
Request for Airport Pick-up
Whether you request an airport pick up or not, please proceed to the link below and
fill out the required arrival confirmation form:
If you have any problems or concerns please feel free to contact our Student
Administrative Support Officer Christopher Acha at: [email protected]
Navitas at UMass Lowell
Student Accommodation at UMass Lowell
Dear Student,
Congratulations on your acceptance to the University of Massachusetts of Lowell.
On behalf of the Navitas at UMass Lowell family I would like to extend a warm
Living in the residence halls affects your entire experience at Navitas at UMass
Lowell. Research shows that students who live on campus earn higher marks in
their academics than those who do not. Students also feel more connected to the
University Family. Navitas at UMass Lowell is dedicated to ensuring all students
succeed in their pathways program and move on successfully to the University.
As you begin the process of signing up for housing, we want to provide you
information and suggestions on how you can be most helpful in this process.
Please be aware of some basic information about the housing process:
As a Navitas PMP student you have the option of living on campus. Please
note that if you would like on-campus housing, you must submit a housing
application by August 1st, 2015 in order to secure a placement.
Typically, first year students are housed together in the same area; the skills
and lifetime friendships you make will ease your transition into the University
The student housing application is included in your packet. All incoming
students should plan to fill out and submit their application.
 Please do NOT submit a housing deposit, this fee is waived
from the application process.
Student Housing is guaranteed for all students that submit their Housing
forms by the August 1st deadline. Housing Assignments will be provided upon
check-in on August 25th, 2015.
Students looking to be housed together must submit a housing application
and send an email to Kyle Lapham, Student Services Officer, at
[email protected] The email must state the name(s) of your
intended roommate(s), with each student sending an email, in order to be
considered for a roommate placement.
Navitas at UMass Lowell
How to manage your assignment expectations:
The first year of college in a new country can be an overwhelming and
challenging experience. The University does its best to make sure your
academic experience is desirable and comfortable.
Please understand the Office of Residence Life does it’s best to accommodate
all requests made by students. Once on campus you will have the
opportunity to request a room change.
Room Changes: On-campus room assignments are for the entire academic year.
The office of Residence Life will consider requests for room changes by the student
after they you been in your residence for two weeks. Changes prior to that time will
be considered only for Emergency or Health cases.
Meal Plans:
All students who are living in traditional style residencies are required to be
on a residential meal plan.
You will be enrolled in the Platinum meal plan with Riverhawk cash to spend
across campus.
Graduate students who are placed into apartments have the option of signing
up for a meal plan.
For more information on dining services and Meal plan options please visit:
If you have any questions please don’t hesitate to contact me. Please call 978-9341902 or email Kyle Lapham at [email protected]
Navitas at UMass Lowell believes that your living experience should be an exciting,
and we look forward to working with you to make it as such.
Good luck with your preparations to attend Navitas at University of Massachusetts
Lowell. We look forward to greeting you.
Kyle Lapham
Student Services Officer
Navitas at UMass Lowell
Brief Information of Residence Halls and Apartments
Each residence hall offers a variety of room options and benefits:
East Campus
Bourgeois Hall
 doubles, triples, and quads
 easy access to the parking garage and bus stop
Donahue Hall
 four-person, six-person, and eight-person suites
 each suite has its own bathroom and common area
Fox Hall
 doubles, triples, and quads
 boasts the largest dining hall on campus
Leitch Hall
 singles (by medical request only), doubles, triples, and quads
 First semester students only. Easy access to Campus Recreation Center
University Suites
 four and six person suites
 steps from the Campus Rec Center
Downtown Lowell
The Inn and Conference Center at UMass Lowell
 doubles and triples
 private bathrooms and individual climate controls
South Campus
Concordia Hall
 singles and doubles
 great open common area on the first floor
Riverview Suites
 four and six person apartments
 full kitchens, living rooms and bathrooms within each unit
Navitas at UMass Lowell
Sheehy Hall
 four-person, six-person, and eight-person suites
 convenient for anyone in a South Campus major
For videos and more information on Residence Halls and Campus Apartments
please visit:
Navitas at UMass Lowell
Off-Campus Housing at UMass Lowell
If you choose to live off-campus it is your responsibility to find and secure an
apartment. You may want to work with a rental agency. There are numerous
options available for off-campus housing including apartments that are furnished
and unfurnished, rooms for rent, studios, and lofts. It is important to consider all
costs when deciding to rent. Below is a table with estimated living expenses for
off-campus housing.
Monthly Estimated Price Guide for
Off-Campus Living in Lowell
$500-$1,000 +/- for 1 bedroom
Gas Heat
$35-$200+/- dependent on weather
$30-$150 +/-
Cable TV, Internet, Phone
Renter’s Insurance (optional)
$30-50 +/-
Contacts to use in your apartment search:
1. Princeton Properties contact : Mary Jo Early
a. Email- [email protected]
b. office phone:978-256-5342
c. cell phone:603-765-6146
2. Heritage Properties
a. Phone- 978-458-3300
b. Fax- 978-458-2900
3. Trulia Real Estate
4. Online Resources
Make sure to read ALL documents prior to signing!
Navitas at UMass Lowell
How to Register for Fall Housing
If you are interested in living on campus starting the Fall Semester please be aware
that now you have to register for Housing directly by submitting a Housing Contract
online. Please click on the link below and follow further instructions.
Click here for the UMass Lowell Fall Housing Link
We do our best to meet your accommodation requirements. However, university
housing often has a limited number of rooms with selected preferences, which are
given to students on a first come first serve basis. This means that your
preferences for housing are not guaranteed.
Please make sure to read the housing policy handbook prior your arrival on
campus. When you arrive, you will be expected to complete a form that states that
you read the handbook and understood the policies. The link to the handbook is
provided below:
If you have any problems or concerns please feel free to contact our Student
Services Officer, Kyle Lapham at: [email protected]
Navitas at UMass Lowell
Are you ready to go to Navitas at UMass Lowell?
Checklist what you must do before arrival:
SEVIS Fee and make appointment at the U.S. Embassy or Consulate
Instruction from the ISSO is included in this packet. Go to the U.S. Embassy or
Consulate and obtain F-1 Visa. Please notify Navitas as soon as you’ve received
your visa.
Initial Invoice for PMP Program
Payment of your initial invoice is due within 14 days of receiving your F-1 visa, or
by August 7th, whichever is earlier. Please note that you will not be enrolled in
classes until your invoice has been paid in full. Payment by August 7th will prevent
delays in your registration.
Navitas PMP Housing Contract 2015 – return August 1st
Please return your Housing Contract (by email) to Navitas at UMass Lowell by
August 1st. We cannot secure campus accommodation at UMass Lowell for you
without this form. Please refer to Housing information sheet in this Packet to get
more information about housing options. Please see the invoice included in this
packet. Any application received after August 1st will not be considered.
UMass Lowell Health Forms
Please submit your completed Health Forms, with all required immunizations, to
Health Service Center (220 Pawtucket St., University Crossing, Suite 300, Lowell,
MA 01854) by the first day of orientation, which is on Wednesday August 26th.
Students in the United States are not allowed to live on-campus or attend classes
without these immunizations, so it is important that these are sent to us prior to
your arrival on campus. If you have questions about the required immunizations,
please feel free to contact Health Services Center via email at
[email protected], or via phone number at 978-934-4991.
Arrival Forms/ Airport Pickup Request – return by August 19th
As soon as you have booked your flights, please email your Arrival Form with your
travel plans to us. It is important that you confirm your travel plans as soon as
possible, so that we can plan for your arrival to campus. If you require an Airport
Pick-up from Boston Logan International Airport, you must also return the enclosed
Navitas at UMass Lowell
Airport Pickup Request by Wednesday August 19th with your full flight itinerary. In
order to reserve the Airport Pick-up, please proceed to the following link: The airport pick-up is $125 USD.
Checklist what you must do upon arrival:
International Orientation is August 26th-28th
Please make travel arrangements to arrive to Boston Logan International Airport no
later than August 25th, 2015. Orientation, which is mandatory for all new students,
begins on Wednesday August 26th so you should plan to arrive in Lowell,
Massachusetts before this date.
The campus residence halls will be open for move-in between 9:00am-9:00pm on
August 25th. Please note that if you arrive before August 25th, you will need to make
arrangements for a place to stay until the residence halls are open. In case of
arrival at the University after 9:00pm, you are responsible for your own overnight
Check in with the International Students and Scholars office (ISSO)
Each semester ISSO requires each international student to register on the SEVIS
system verifying enrollment as a full-time student and confirmation of US address.
Failure to do this automatically cancels the student’s immigration status.
All Navitas students must register with ISSO during Orientation. Required
documents for check-in include: passport, I-20, visa, copies of I-94.
I-94 information is available through
Navitas at UMass Lowell
Health Forms Letter
Dear future Navitas student,
Congratulations on being accepted to Navitas at UMass Lowell.
Please note that our process of receiving your health forms has changed.
Please do not send Health forms directly to Navitas at UMass Lowell.
Al l students are required to fill out Health forms. Health forms can be mailed to the
address below or students can bring forms to Orientation.
UMass Lowell
Student Health Services
University Crossing Suite 300
220 Pawtucket Street
Lowell, MA 01854
International Students: As authorized under the insurance laws for higher
education, students in Massachusetts (section 275 of Chapter 151 of the Acts of
1996), the University of Massachusetts Lowell requires that all
international students must enroll in the University’s Student Health
Insurance Plan.
Thank you for your cooperation.
We look forward to welcoming you to the University.
Kyle Lapham
Student Services Officer
Navitas at UMass Lowell
University of Massachusetts Lowell
Health Services – Wellness Center
220 Pawtucket St., Suite 300
Lowell, Ma 01854-5144
Tel: 978-934-4991
Fax: 978-934-3080
CONSENT FOR TREATMENT for under 18 Students
I hereby give permission for medical treatment for my dependent , _____________________________,
if an accident or illness should occur while he/she is a student at the University of Massachusetts Lowell.
This includes referral to a local hospital or hospitalization, should it be necessary and I am unable to be
This permission shall be granted for the period of one academic semester and must be renewed every
semester that my child is a student at the University of Massachusetts Lowell.
Child’s full name (please print)
(date of birth)
Parent/Guardian name (please print)
Signature: ________________________________________
Navitas Student
University of Massachusetts Lowell
Wellness Center
220 Pawtucket Street, Suite 300
Lowell, MA 01854-5144
Tel: (978) 934-6800 Fax: (978) 934-3080
(Page 1 of 2)
Home Address:
Local Address:
Phone Number: (home)
Please answer the following questions:
1. Have you ever been in a close contact with anyone sick with tuberculosis?
2. Were you born in one of the countries listed below?
If yes, what country:
Date of entry to United States:
3. Have you lived or traveled for more than one month in one or more of the countries listed below?
If yes, what country/ies:
If the answer is NO to all of the above questions, no further testing is required. Submit form to Health Services
If the answer is YES to any of the above questions, UMASS Lowell Health Services requires you to have a tuberculosis skin test (TST) to
check for latent tuberculosis infection (LTBI). TST must be completed no more than 6 months before the start of classes. TST preferred to be
completed in USA. Continue to Page 2 of this form.
Bosnia & Herzegovina
Brunei Darussalam
Burkina Faso
Cape Verde
Central African Republic
Congo DR
Cote d’Ivoire
Dominican Republic
El Salvador
Equatorial New Guinea
Libyan Arab Jama
Marshall Islands
New Caledonia
Northern Mariana Island
Papua New Guinea
Russian Federation
St. Vincent & Grenadines
Sao Tome & Principe
Sierra Leone
Solomon Islands
South Africa
Sri Lanka
Syrian Arab Republic
*World Health Organization Global Tuberculosis Control. WHO Report 2010.
Rev: 15/05
University of Massachusetts Lowell
Wellness Center
220 Pawtucket Street, Suite 300
Lowell, MA 01854-5144
Tel: (978) 934-6800 Fax: (978) 934-3080
(Page 2 of 2)
Middle Initial
Country of Birth:
Home Address:
Local Address:
Phone Number: (home)
Tuberculin Skin Test (TST)
Plant date:
Read date*:
*48-72 hours after plant date
mm of induration
^Positive Negative
**If no induration, write “0". See interpretation guidelines below. ^If positive, continue below.
If POSITIVE Tuberculin Skin Test (now or by history) the following are required:
Date of Positive TST:
Chest X-ray:
Abnormal (attach report, NOT the X-ray)
Clinical Evaluation:
mm of induration
Drug/s, dose frequency, and dates:
Medical Provider
**Interpretation Guidelines
5 mm or greater is positive:
10 mm or greater is positive:
• Recent close contacts of an individual
with infectious TB
• Persons with fibrotic changes on a prior
chest x-ray consistent with past TB
• Organ transplant recipients
• Immunosuppressed persons: taking > 15
mg/d; of prednisone for > 1 month;
taking a TNF-a antagonist
• Persons with HIV/AIDS
• Persons born in a high prevalence country or who resided in one for a significant
amount of time
• History of illicit drug use
• Mycobacteriology laboratory personnel
• History of resident, worker or volunteer in high-risk congregate settings
• Persons with the following clinical conditions: silicosis, diabetes mellitus, chronic
renal failure, leukemias and lymphomas, head, neck or lung cancer, low body
weight (>10% below ideal), gastrectomy or intestinal bypass, chronic
malabsorption syndromes
15 mm or greater is
• Persons with no
known risk factors for
TB disease
Rev: 15/05
Information about Meningococcal Disease and Vaccination
Waiver for Students at Residential Schools and Colleges
Massachusetts requires all newly enrolled full-time students attending a secondary school (e.g., boarding schools) or
postsecondary institution (e.g., colleges) who will be living in a dormitory or other congregate housing licensed or approved
by the secondary school or institution to:
1. receive meningococcal vaccine; or
2. fall within one of the exemptions in the law, which are discussed on the reverse side of this sheet.
The law provides an exemption for students signing a waiver that reviews the dangers of meningococcal disease and
indicates that the vaccination has been declined. To qualify for this exemption, you are required to review the information
below and sign the waiver at the end of this document. Please note, if a student is under 18 years of age, a parent or legal
guardian must be given a copy of this document and must sign the waiver.
What is meningococcal disease?
Meningococcal disease is caused by infection with bacteria called Neisseria meningitidis. These bacteria can infect the
tissue that surrounds the brain and spinal cord called the “meninges” and cause meningitis, or they can infect the blood or
other body organs. In the US, about 1,000-3,000 people get meningococcal disease each year and 10-15% die despite
receiving antibiotic treatment. Of those who live, another 11-19% lose their arms or legs, become deaf, have problems with
their nervous systems, become mentally retarded, or suffer seizures or strokes.
How is meningococcal disease spread?
These bacteria are passed from person-to-person through saliva (spit). You must be in close contact with an infected
person’s saliva in order for the bacteria to spread. Close contact includes activities such as kissing, sharing water bottles,
sharing eating/drinking utensils or sharing cigarettes with someone who is infected; or being within 3-6 feet of someone who
is infected and is coughing or sneezing.
Who is at most risk for getting meningococcal disease?
High-risk groups include anyone with a damaged spleen or whose spleen has been removed, those with persistent
complement component deficiency (an inherited immune disorder), HIV infection, those traveling to countries where
meningococcal disease is very common, microbiologists and people who may have been exposed to meningococcal
disease during an outbreak. People who live in certain settings such as college freshmen living in dormitories and military
recruits are also at greater risk of disease.
Are some students in college and secondary schools at risk for meningococcal disease?
College freshmen living in residence halls or dormitories are at an increased risk for meningococcal disease as compared
to individuals of the same age not attending college. The setting, combined with risk behaviors (such as alcohol
consumption, exposure to cigarette smoke, sharing food or beverages, and activities involving the exchange of saliva), may
be what puts college students at a greater risk for infection. There is insufficient information about whether new students in
other congregate living situations (e.g., residential schools) may also be at increased risk for meningococcal disease. But,
the similarity in their environments and some behaviors may increase their risk.
The risk of meningococcal disease for other college students, in particular older students and students who do not live in
congregate housing, is not increased. However, meningococcal vaccine is a safe and efficacious way to reduce their risk of
contracting this disease.
Is there a vaccine against meningococcal disease?
Yes, there are currently 2 types of vaccines available that protect against 4 of the most common of the 13 serogroups
(subgroups) of N. meningitidis that cause serious disease. Meningococcal polysaccharide vaccine is approved for use in
those 2 years of age and older. There are 2 licensed meningococcal conjugate vaccines. Menactra® is approved for use in
those 9 months – 55 years of age and Menveo® is approved for use in those 2-55 years of age. Both the polysaccharide
and conjugate vaccines provide protection against four serogroups of the bacteria, called groups A, C, Y and W-135. These
four serogroups account for approximately two-thirds of the cases that occur in the U.S. each year. Most of the remaining
one-third of the cases are caused by serogroup B, which is not contained in either vaccine. Meningococcal vaccines are
thought to provide protection for approximately 5 years. Currently, students are only required to have a dose of
polysaccharide vaccine within the last 5 years or a dose of conjugate vaccine at any time in the past (or fall within one of
the exemptions allowed by law).
(See reverse side)
However, please be aware that in October 2010 the Advisory Committee on Immunization Practices (ACIP) recommended
booster doses of meningococcal conjugate vaccine for healthy adolescents 16-18 years of age. Persons up to 21 years of
age entering college are recommended to have documentation of a dose of meningococcal conjugate vaccine no more than
5 years before enrollment, particularly if they are new residential students.
Is the meningococcal vaccine safe?
A vaccine, like any medicine, is capable of causing serious problems such as severe allergic reactions. Getting
meningococcal vaccine is much safer than getting the disease. Some people who get meningococcal vaccine have mild
side effects, such as redness or pain where the shot was given. These symptoms usually last for 1-2 days. A small
percentage of people who receive the vaccine develop a fever. The vaccine can be given to pregnant women. Anyone who
has ever had Guillain-Barré Syndrome should talk with their provider before getting meningococcal conjugate vaccine.
Is it mandatory for students to receive meningococcal vaccine for entry into secondary schools or colleges that
provide or license housing?
Massachusetts law (MGL Ch. 76, s.15D) requires newly enrolled full-time students attending a secondary school (those
schools with grades 9-12) or postsecondary institution (e.g., colleges) who will be living in a dormitory or other congregate
housing licensed or approved by the secondary school or institution to receive meningococcal vaccine. At affected
secondary schools, the requirements apply to all new full-time residential students, regardless of grade (including grades
pre-K through 8) and year of study. All students covered by the regulations must provide documentation of having received
a dose of meningococcal polysaccharide vaccine within the last 5 years (or a dose of meningococcal conjugate vaccine at
any time in the past), unless they qualify for one of the exemptions allowed by the law. Whenever possible, immunizations
should be obtained prior to enrollment or registration. However, students may be enrolled or registered provided that the
required immunizations are obtained within 30 days of registration.
Students may begin classes without a certificate of immunization against meningococcal disease if: 1) the student has a
letter from a physician stating that there is a medical reason why he/she can’t receive the vaccine; 2) the student (or the
student’s parent or legal guardian, if the student is a minor) presents a statement in writing that such vaccination is against
his/her sincere religious belief; or 3) the student (or the student’s parent or legal guardian, if the student is a minor) signs
the waiver below stating that the student has received information about the dangers of meningococcal disease, reviewed
the information provided and elected to decline the vaccine.
Where can a student get vaccinated?
Students and their parents should contact their healthcare provider and make an appointment to discuss meningococcal
disease, the benefits and risks of vaccination, and the availability of this vaccine. Schools and college health services are
not required to provide you with this vaccine.
Where can I get more information?
Your healthcare provider
The Massachusetts Department of Public Health, Division of Epidemiology and Immunization at (617) 983-6800
or and
Your local health department (listed in the phone book under government)
Waiver for Meningococcal Vaccination Requirement
I have received and reviewed the information provided on the risks of meningococcal disease and the risks and benefits of
meningococcal vaccine. I understand that Massachusetts’ law requires newly enrolled full-time students at secondary
schools, colleges and universities who are living in a dormitory or congregate living arrangement licensed or approved by
the secondary school or postsecondary institution to receive meningococcal vaccinations, unless the students provide a
signed waiver of the vaccination or otherwise qualify for one of the exemptions specified in the law.
After reviewing the materials above on the dangers of meningococcal disease, I choose to waive receipt of
meningococcal vaccine.
Student Name: ____________________________________________ Date of Birth: _________________
Student ID or SSN: ________________________________________________________________________
Signature: __________________________________________________ Date: _________________
(Student or parent/legal guardian, if student is under 18 years of age)
Provided by: Massachusetts Department of Public Health / Division of Epidemiology and Immunization / 617-983-6800
MDPH Meningococcal Information and Waiver Form
Reviewed July 2014
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