Submit your completed request here
- Quick tip Vaccine Submission Guide in English
- Quick tip Vaccine Submission Guide in Spanish
- Quick tip Vaccine Submission Guide in Simplified Chinese
- COVID Vaccine Exemption Process Tip Sheet
To request:
Medical exemption or Disability exception, based (a) Medical Exemption due to a Contraindication or Precaution to COVID-19 vaccination recognized by the U.S. Centers for Disease Control and Prevention (CDC) or by the vaccines’ manufacturers; (b) Medical Exemption due to COVID-19 diagnosis or treatment within the last 90 days; or (c) Disability accommodation, which includes *pregnancy, childbirth, or a related medical condition where reasonable accommodation is medical advisable download and complete the Medical Exemption-Disability Exception Request Form SARS-CoV-2
Note that a Medical Exemption-Disability Exception Request Form SARS-CoV-2 Certification must be approved and signed by a physician, nurse practitioner or other licensed medical professional practicing under the license of a physician.
Medical Exemption-Disability Exception SARS-CoV2 Fillable Request Form
CERTIFICATION FROM HEALTH CARE PROVIDER FOR MEDICAL EXEMPTION AND/OR DISABILITY EXCEPTION
Deferral* request due to pregnancy download and complete the Deferral Request Form SARS-CoV-2.
DEFERRAL REQUESt FILLABLE FORM SARS-CoV-2
Religious Objection Request, which is based on a sincerely held belief, practice, or observance that conflicts with the University’s COVID-19 vaccination requirement download and complete the RELIGIOUS Exception REQUEST FILLABLE FORM SARS-CoV-2.