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District Physical and Immunization Compliance Data

Proof of a physical examination is required by September 1st of the year of the required exam or within 30
days of enrollment for new students from outside the state. The exam must be dated within 1 calendar
year of the start date for:

• Preschool

• Kindergarten

• Sixth grade

• Ninth grade

Physical exams may be acquired through your primary medical provider. If you do not have a primary medical provider, you may contact your building nurse.

Physical Exam Form

Immunization requirements enforced in accordance to the CDC schedule and Illinois law. The minimum requirements can be found by clicking here.

AFTER SEPTEMBER 1ST UNIT 4 STUDENTS WILL NOT BE ALLOWED TO ATTEND
SCHOOL WITHOUT THE REQUIRED IMMUNIZATIONS AND PHYSICAL EXAM.

Make an appointment NOW for a physical and immunizations! Avoid the rush.
No appointment cards will be accepted in place of a completed exam form and
immunization record.

• Religious: Parents/Guardians requesting religious exemption from health requirements must complete the required form along with their child’s healthcare provider.

Illinois Religious Exemption Form

• Medical: If a physical condition prevents the administration of vaccines, the healthcare provider should indicate this on the physical exam form, or provide a letter. Depending on the situation or medical condition, this may need to be reviewed annually.

**The athletic physical assessment does not meet the sixth, or ninth grade physical exam requirement.

The State of Illinois requires that all students in Kindergarten, second, sixth and ninth grades have an oral health examination performed by a licensed dentist.

Following your child's exam, please have your dentist fill out the form required by the State and return it to the school office no later than May 15 of the year of the required exam. The exam must have been performed any time within an 18-month period prior to this due date. Exam forms are also available at your dentist's office.

If you need a referral to find a dentist, please contact your building nurse. Champaign-Urbana Public Health Department brings a dental clinic with exam and cleaning to all Unit 4 Schools once a school year.

Dental Exam Form

CUPHD

The State of Illinois requires that all students entering Kindergarten OR entering an Illinois school for the first time shall have an eye examination before October 15 of the year of the required exam, or within 30 days of enrollment for new students from out-of-state. The exam must have been performed any time within a 12 month period prior to this due date.

State of Illinois Vision Exam Form