Please complete the following items by the given deadlines. If you have any questions regarding these items, please contact Julie Kesterke at 612-626-7476 or at

Immunization Form

The University of Minnesota requires ALL students to have an immunization form on file with Boynton Health Services. You must fill out this form in order for us to register you for classes, thus please do so as soon as possible, and no later than August 1, 2014.

To complete your form fill out the or complete the printable PDF version (You cannot complete either version until you have received your Student ID).

The printable PDF form must be completed and returned to Boynton Health Service Please keep a copy for your personal records and mail the original to: Boynton Health Service, Attn: Patient Assistance, 410 Church Street S.E., Minneapolis, MN 55455. Or fax to (612) 625-1434.

New Student Information Form

This form will provide us with more information on your job, who you are as a individual, your preferred method of contact prior to starting school, your emergency contact information and dietary preferences. Do note that information about your job, preferred telephone number, and information on who you are as individual will be shared with students, faculty and staff. Emergency contact information, dietary preferences and personal/work contact information will only be used by the CEMBA program staff.

Please fill out this form online as soon as possible, and no later than August 1, 2014.


  • 612-625-5555