COVID-19 Vaccination Exemption Request

Exemption Request Information

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Reason for Request(Required):

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For which reason are you requesting exemption?

Your Campus(Required):

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Your Information

Your Name

Phone number

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Reason for Request

Please indicate if you are requesting a religious exemption or medical exemption, and read the relevant information below.

1. Are you requesting a religious exemption? As a private institution, we reserve the right to fully evaluate all religious exemption requests. To request a religious exemption, respond to the three questions below.(Required)

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1a. What is the religious reason for your request? Write a thorough explanation of the reason for your exemption request in your own words. This field is required.

1b. What sincerely-held religious belief guides your objections? Write a detailed description of the sincerely-held religious belief that guides your objections. This field is required.

1c. Does your sincerely-held religious belief constitute an objection to all immunizations or only the COVID-19 vaccination? If your belief does not constitute an objection to all immunizations, you must explain the religious basis for not receiving this particular immunization. This field is required.

2. Are you requesting a medical exemption? A student may be exempted from the COVID-19 Vaccination Requirement if they have medical contraindications, precautions, or other medical conditions/disabilities for which a licensed healthcare provider certifies that the individual is unable to receive the vaccine. Medical contraindications or precautions to COVID-19 vaccination are those that are recognized by the U.S. Centers for Disease Control and Prevention. Contraindications and precautions are a condition that may increase the risk for a serious adverse reaction to the vaccine, may cause diagnostic confusion if the vaccine is administered, or may compromise the ability of the vaccine to produce immunity.  A licensed medical provider must complete the COVID 19 Vaccination Requirement Medical Exemption Request for Students form, and the completed form must be attached below. The required form is available at the link at the top of this form.(Required)

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Required Documentation for Medical Exemption Requests

Please upload your completed COVID-19 Vaccination Requirement Medical Exemption Request for Students form here. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Exemption Request Information

Your Information

Reason for Request

Required Documentation for Medical Exemption Requests

Submission