Non-Credit Programs

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Medical Information & Required Participation Forms

In order to provide for the health and well-being of each participant during our programs, we ask that parents provide medical information and a recent copy of their prescription/medical insurance card to our office. In the event of an accident or visit to the hospital, this information will aid us in expediting medical care.

Please read, sign, and return the following notice and permission forms prior to the program start date. Please Note: If you need any forms in an alternate format, or need assistance, please contact our office at 309/298-1911, or toll-free at (866)933-8964.

• MDH Notice of Privacy Practices (PDF)
• Beu Notice of Privacy Practices (PDF)
• Western Medical Form (PDF)
• Beu Parental Permission Form (PDF)
• Photo Permission Form (PDF)

The following medical forms are provided in PDF format and require the latest version of Adobe Acrobat to read and/or print.

Download Adobe Acrobat

Non-Credit Programs - School of Extended Studies
Western Illinois University • Horrabin Hall 6
Macomb, Illinois 61455
Phone: (309) 298-1911 • Toll-free: (866) 933-8964 • Fax: (309) 298-2226
E-mail: Non-Credit@wiu.edu • Contact Us