All required forms are due by May 25, 2022
MICA's COVID-19 Operational Mode:
Effective May 23, 2022 MICA will be functioning in a modified Operational Mode 5 and will continue during the Summer and Fall 2022 semesters.
Social Agreement & Contract
Parent/Guardians will receive an electronic agreement via Docusign prior to the start of the program that requires a signature in order for the student to participate in PreCollege. This agreement will outline all program rules and regulations, including those related to COVID-19, and is part of a single document that combines the Social Agreement and Rules and Responsibilities. This document is sent to the MICA email associated with each student. To access MICA email: Go to accounts.google.com > Login with your MICA email and password > Email: (username)@mica.edu, Password: created during account activation.
(Due May 25, 2022)
Health History Forms:
All Forms must be completed and uploaded to MICA's Medicat system by May 25, 2022
All questions related to Health Forms should go directly to firstname.lastname@example.org
- Download Forms
- Meningitis Waiver Form
- COVID-19 Vaccine Medical Exemption Request Form
- COVID-19 Vaccine Religious Exemption Request Form
- MICA Health History Form
- Parental Permission Medical Care
- Maryland Minor Consent Laws
- Chase Brexton Consent Form
- Physician completes and signs all Health Forms
- Use your MICA credentials to log into the Medicat system and upload your completed forms
*Students will receive their MICA credentials in early May in order to upload completed forms. Do NOT submit any health records via email. Please hold on to completed forms until the portal is active for students. Once emails are sent for setting up MICA credentials if you have any questions related to this you can email email@example.com for assistance.
MICA requires your physician to sign a statement that you are in good physical and mental health, that your immunizations are up to date, provide details regarding your immunization record, and specifically complete all required information and vaccines in order to attend MICA's PreCollege Program.
In order to provide students with the best possible care, we urge you to submit complete and accurate health information. Please complete the forms in full, and be sure to include all prescribed medications and allergies, in case of an emergency. A student’s health information will go directly to MICA's Chase Brexton Health Services and is required in order to attend PreCollege.
MICA Student Health Services by Chase Brexton:
Students may use the health services provided by Chase Brexton, located on MICA’s campus, and operated by Chase Brexton Health Services. Chase Brexton is staffed by board certified nurse practitioners, and they are able to treat minor illnesses, or injuries sustained during your summer program, but will refer possible Covid-19 cases to a nearby urgent care or emergency room for testing and treatment. Visits to the Chase Brexton health center are covered by your PreCollege program fees, but program fees do not cover the cost of medications or laboratory testing, so any such costs and charges would be additional and are the sole responsibility of the student and/or parent/guardian. We suggest that students bring petty cash or a debit card to pay for prescription medications, should they be prescribed medication while attending PreCollege. MICA PreCollege staff are unable to pay for any medications, lend students money for medications or otherwise assist in payment for this purpose. Chase Brexton Health Services has limited hours, and is available for nurse triage visits only. Students who become ill or injured after hours will be taken to the nearest hospital emergency room. Therefore it is imperative that students carry health insurance to cover the costs associated.
Medical Insurance Coverage:
All students that attend MICA’s Pre-College program are required to have individual health insurance coverage. Students must have a health insurance provider that is accepted by our on campus Student Health Services, Chase Brexton. Please speak directly to Chase Brexton Health Services for a list of accepted insurance providers at 410-225-4118.
Short Term Health Insurance Form
Short term health insurance to cover the duration of the program is available for purchase through MICA if needed. *Please note that all international students are required to purchase the MICA short term insurance policy regardless if they also purchased additional travel or medical insurance. Requests for assistance in purchasing short term health insurance can be sent to firstname.lastname@example.org.
All students are responsible for managing all personal medications, including both over the counter and prescription drugs. Staff members are not responsible for reminding students to take medications, storing medications, monitoring usage, and cannot assist in the distribution or taking of medication.
Students and their families are responsible creating a safe plan of action and support with their family physician, therapist, and/or counselor. MICA is unable to provide counseling or therapy for PreCollege students on campus, and students may only leave campus through a Student Release and Guest form, with an approved adult escort, during times that do not impact the academic requirements of the program.
If an ambulance is necessary, dial 911 and request an ambulance. Tell them your situation and the location If you are in the residence halls, give the room number or the location of the emergency and the address:
120 McMechen Street Baltimore, MD 21217
Then call Campus Safety at 443-423-3333. The Campus Safety dispatcher will contact Pre-College and Campus Safety staff, who will assist you. If an ambulance is not necessary, but you or another student needs medical assistance, contact a member of the pre-college program staff.
● If you have a fire in your apartment, get out of the apartment, shut the door, and activate a hand- pull alarm. Then proceed down the stairwell to the designated evacuation location. Report the fire’s location by following steps numbers 1 and 2 under Medical Emergency. Never prop stairwell doors.
● If the smoke detector goes off and you smell smoke, get out of the apartment, ducking underneath the smoke, shut the apartment door, and activate the hand-pull alarm in the stairwell. Then proceed down the stairwell and to the front of the designated evacuation area. Report what happened by following steps numbers 1 and 2 under Medical Emergency. Never prop stairwell doors.
● If you think that your smoke detector is defective, ask the front desk staff to put in a work request immediately. Staff will check it quickly. If it is beeping periodically, our staff may just need to replace the battery. You cannot turn off or cover your smoke detector. Remember tampering with or disconnecting a smoke detector or other fire equipment is prohibited because it endangers you and others. Severe disciplinary action will be taken if you tamper with any safety equipment. If you suspect that your smoke detector is not working properly, ask that it be checked.
All residents and guests must evacuate their apartments when a fire alarm sounds. Walk quickly to the nearest stairwell and go out of the nearest exit to the designated gathering point. Never prop stairwell doors. Follow the directions of all pre-college, Campus Safety staff, and any fire personnel. Tampering with any fire safety device (including smoke detectors, fire extinguishers, or fire alarms) is expressly prohibited and considered a serious violation. Disciplinary action will include dismissal from the Pre-College program, and possibly arrest and prosecution.
In the interest of fire safety, the following items have been banned from campus housing and will be confiscated: Halogen floor lamps, Candles and Incense. In addition, only UL-approved electrical products may be used in campus housing. All extension cords and plug strips must be UL approved. Please look for the “UL” symbol on products before bringing them to campus.
A maintenance emergency is anything that is likely to affect the safety of students or cause immediate harm to property. Examples are: a major water leak, broken plumbing, or a broken window. Contact your RA or call the 24-hour desk in the residence hall to report the emergency situation. The security guard will contact the appropriate staff and will take steps to see that the emergency is resolved. If the situation is not an emergency (i.e. broken A/C or window blinds), complete a maintenance request at the Pre-College Office as soon as you are able.
Personal & Community Safety for on Campus and Surrounding Area
Campus facilities have been designed with a variety of safety features intended to augment the security services provided by Community Safety. Among them are:
● A 24-hour security guard at the residence hall front desk
● Closed-circuit TV monitoring the facilities
● Enclosed living space and courtyard security screens on all accessible exterior windows
● Window stops on interior windows on the courtyard side of the Residence halls
● Campus Safety officers are posted around campus during peak travel times between and after
In addition to these physical features, Pre-College staff complete daily checks of the residence halls. While Campus Safety staff work around the clock, there are some precautions we ask you to take to minimize the possibility of crime on campus and to ensure your own safety. The most important precaution you can take is to always be aware of your surroundings, both on and off-campus. Students must work together with staff to ensure their safety.
Pre-College students are encouraged to travel in groups of three when going anywhere. If not in a group, students should be accompanied by a Pre-College staff member.
Being safe in and around the campus means doing the following:
● Using the main entrance for coming and going and showing your MICArd
● Never propping open entrances to buildings and always alerting staff if you see open doors
● Reporting strangers immediately
● Reporting anything that makes you feel unsafe, no matter how small, to the 24-hour desk
● Locking your apartment door and always take your room key and MICArd with you when you
leave your apartment
● Keeping the window stops in place on your interior windows and never opening your interior
windows farther than the locks allow
● Keeping your window screens in place
● Never leaving valuables in your apartment in plain view
● Taking the campus shuttle to and from campus buildings at night
● Traveling in larger groups (minimum of 3)
● Adhering to curfews and proximity restrictions
● Staying alert and walking directly
● Not allowing yourself to be distracted by screens or listening to music. Keeping electronics
hidden and out of sight
Unless you take these precautions, the safety features provided will not work. Please remember if you do not follow these guidelines, not only are you jeopardizing your own safety, but also the safety of everyone else in the campus community.