DPS 109 Health Requirements Submission Form

DPS 109 Health Requirements Submission Form

- ONE FORM PER DPS 109 STUDENT -
Student's Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Grade Level for 2024-2025 School Year
School of Attendance for the 2024-2025 School Year*
Where to Submit Your Files

Please use the upload tool below to securely provide school health requirements including Physical Examinations, Immunizations, Eye Examinations, and Dental Examinations. For your convenience, multiple files can be uploaded in one submission. Please remember to upload all pages of the forms to meet the requirements.

*Please Note: In lieu of the immunization and health examination, parents/guardians may submit the: Illinois Certificate of Religious Exemption to Required Immunizations and/or Examinations Form.
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Where to Submit Your Files