Health Requirements & Forms

  • State of Illinois law requires school districts to have certain health information on file for students entering a specific grade including verification of immunizations as well as physical, dental, and eye examinations. Students who do not have a current physical exam and immunization records on file will be excluded from school (including summer school) until all health requirements are met.

    A complete list of physical examination and immunization requirements is available on the Health Requirements for Grades 9-12 page. Below are many of the forms you and your health care provider will need in order to meet these requirements. To discuss health requirements or forms with a school nurse, call (847) 424-7260.

Illinois Health Forms

  • Illinois Certificate of Child Health Examination Form

    State of Illinois law requires proof of a physical examination dated no earlier than one year prior to a student entering grade 9, for all students entering the district for the first time, and for all students entering District 202 from outside the State of Illinois or the United States. Proof of physical exam and immunization dates and records must be submitted on the Child Health Examination Form. Download this form and have it completed, signed, stamped and dated by your child's health care provider.

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  • Illinois Certificate of Religious Exemption Form

    Religious Objections to Immunizations and/or Examinations: 

    As of October 16, 2015, parents or guardians requesting a religious exemption must submit the Illinois Certificate of Religious Exemption form signed by parent and the student’s health care provider. A completed and signed form must be on file prior to the start of school for any family seeking an exemption.

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  • Illinois Dental Examination Form

    In compliance with Illinois Public Act 093-0946, by May 15th of that school year, students entering grade 9 are required to have a dental exam on file. School dental examinations must have been completed within 18 months prior to the May 15 deadline. Download this form and have it completed, signed and dated by your child's dentist.

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  • Illinois Eye Exam Form / Vision and Hearing Screenings

    The Illinois School Code 410 ILCS 205/3 requires that a child has an eye exam by an optometrist or physician (such as an ophthamologist) who provides eye examinations prior to entering kindergarten or entering a public, private or parochial school for the first time and no later than their first year in public school. Vision and hearing screenings are completed at ETHS annually for all students in special education and for all students new to the district. Vision or hearing screenings may also be requested by a parent, student, teacher or staff member.

     

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Asthma Action Plan

  • Asthma Action Plan

    The Illinois School Code 105 ILCS 5/22-30 requires Evanston Township High School to request an Asthma Action Plan (AAP) from parents/guardians of students with asthma each school year. You may elect to use the plan provided here by the American Lung Association, or one from your own health care provider. The action plan requires a signature from both the health care provider and the parent/guardian.

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Medication Authorization Form

  • Medication Authorization Form

    To gain authorization for a new medication or change in medication, submit the Medication Authorization Form along with the prescription medication in its original container from the pharmacy to the school nurse at the beginning of the school day. This can also be done prior to the start of the school year for routine medications. Download this form and have it completed, signed and dated by the health care provider who prescribed the medication.
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Health Notices for Incoming Freshmen

  • ETHS Physical Exam and Immunization Requirements

    Illinois state law requires each student to have a physical examination performed by a licensed health care provider (MD, DO, APN, or PA). State law also requires each student to show evidence of the immunizations outlined in the Physical Exam and Immunization Requirements document below. Evanston Township High School District 202 has a policy of first day exclusion. Students who do not have a current physical exam and immunization records on file will be excluded from school until such requirement is met. In addition, all students who will be attending summer school at ETHS will need to have their physical examination completed and turned in to the Nurses' Office before the start of summer school.
     
    The school-based ETHS Health Center can provide physicals for incoming 9th grade students at low to no cost. Free or low cost immunizations are available to students meeting certain criteria. To schedule an appointment, please call 847-424-7265. Parents/guardians can also choose to schedule their child’s physical exam and immunizations with their family health care provider.
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  • Incoming Freshmen: Due Dates for Required Health Information

    Health forms for students enrolling in grade 9 are due to the ETHS Health Services (Nurses’) Office, room N121, by the dates listed in this PDF. This includes the deadline for incoming freshmen who plan to attend Summer School at ETHS.

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  • Illinois Certificate of Child Health Examination Form

    State of Illinois law requires proof of a physical examination dated no earlier than one year prior to a student entering grade 9, for all students entering the district for the first time, and for all students entering District 202 from outside the State of Illinois or the United States. Proof of physical exam and immunization dates and records must be submitted on the Child Health Examination Form. Download this form and have it completed, signed, stamped and dated by your child's health care provider.

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  • Illinois Certificate of Religious Exemption

    Religious Objections to Immunizations and/or Examinations

    As of October 16, 2015, parents or guardians requesting a religious exemption must submit the Illinois Certificate of Religious Exemption form signed by parent and student’s health care provider. Form will be required to start classes.

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  • Illinois Dental Examination Form

    In compliance with Illinois Public Act 093-0946, by May 15th of that school year, students entering grade 9 are required to have a dental exam on file. School dental examinations must have been completed within 18 months prior to the May 15 deadline. Download this form and have it completed, signed and dated by your child's dentist.

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  • Illinois Asthma Action Plan

    Illinois school code now requires schools to request an Asthma Action Plan for each student with asthma. Click on the link above to open the Asthma Action Plan form. The doctor, nurse practitioner or physician's assistant that manages your student's asthma can complete this form or use their own form. Once completed and signed by the parent or guardian, the form must be submitted to the Nurses' Office, Health Services Department, in one of the following ways. 

    By Mail:
    Evanston Township High School
    Health Services, Room N121
    1600 Dodge Ave
    Evanston, IL 60202

    By Fax:  847-424-7254

    Scan and email to: nurses@eths.k12.il.us

    Drop Off In Person: Forms may be dropped off to the Nurses' Office, Health Services Department, Room N121 during the hours listed on this page. Forms may also be dropped off at either Entrance #1 or Entrance #2 (please use an envelope marked "Health Services").

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  • Incoming Freshmen: Health Requirements Parent Letter

    Information sent to parents of incoming freshmen regarding the health and immunization requirements to attend ETHS.

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  • Incoming Freshmen: Physical Exams and Immunizations at ETHS Health Center

    The ETHS Health Center is a partnership between NorthShore University HealthSystem, Evanston Township High School, and the Evanston Department of Health and Human Services with funding from the Illinois Department of Public Health. Health Center staff provide ongoing care to students with acute or chronic conditions, and perform physical exams for incoming and new students as well as annual sports physicals for current students in grades 9-12.
     
    The ETHS Health Center offers physical exam appointments to eighth graders who will be attending ETHS. If you would like your student to receive services at the ETHS Health Center such as a physical exam, please call now to schedule your exam. Please note: We do not provide routine vaccines to children with private health insurance. For more information or to schedule an appointment, call 847-424-7265.
     
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