Division of Graduate Professional Studies
Brandeis University
Rabb School of Continuing Studies
415 South Street
P.O. Box 549110, Mailstop 084
Waltham, MA 02454-9110

781-736-8787 Phone
781-736-3420 FAX

gps@brandeis.edu
www.brandeis.edu/gps

Students registered for three courses
in a single term must provide adequate proof of immunization against measles, mumps, rubella, and tetanus-diphtheria by completing the health form and are required to provide proof of health insurance coverage. Please complete all of the information requested below, and contact the Brandeis University Health Center: http://www.brandeis.edu/studentaffairs/health/graduate/insurance.html

Note: This form must be completed only during the registration period.

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