Medical Information

  • Immunizations

    Date, if known
  • Health Insurance

    (required)
  • Emergency Contact Information

  • PLEASE READ

    By submitting this form you acknowledge that travelers' health information is available to you and you will avail yourself of such information at the Center for Disease Control website at www.cdc.gov/travel You also hereby certify that you have made full and complete disclosure.
  • Nondescrimination Statement

    Hannibal-LaGrange University complies with all federal and state nondiscrimination laws and does not engage in prohibited discrimination on the basis of race, color, sex, religion, disability, national or ethnic origin or ancestry, military or veterans status, or genetic information in either employment or the provision of services. As an institution controlled by the Missouri Baptist Convention, the University is exempted from some provisions of nondiscrimination laws, including the prohibition against religious discrimination in employment under Title VII of the Civil Rights Act of 1964, and, to the extent compliance would conflict with the University’s religious tenets, the prohibition against sex discrimination under Title IX of the Education Amendments of 1972.

    A student or one seeking admission to Hannibal-LaGrange University, who claims to have been unlawfully discriminated against due to any University regulation, policy, or the official action of any University employee should submit a written complaint to Karry Richardson at HLGU, 2800 Palmyra Road, Hannibal, Missouri, 63401 or via email at krichard@hlg.edu.

    An employee or one seeking employment who claims to have been unlawfully discriminated against due to any University regulation, policy, or the official action of any University employee should submit a written complaint to Dori Colborn at Business Office, 2800 Palmyra Road, Hannibal, Missouri, 63401 or via email at dori.colborn@hlg.edu.

    Approved by HLGU Board of Trustees October 14, 2016.