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Statement of Immunization Exemption - Millersville University - millersville 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your M# in the designated field at the top of the form.
- Fill in your full name and date of birth accurately to ensure proper identification.
- Review the immunization requirements listed. Check the boxes next to DTP and MMR if applicable, indicating your compliance.
- In the 'REASON FOR EXEMPTION' section, print your name clearly where indicated.
- Select either 'Medical' or 'Religious' as your reason for exemption and provide a detailed written statement as required.
- Sign and date the form at the bottom, acknowledging your understanding of the risks involved with not receiving vaccinations.
- If available, attach any documentation from a medical provider that supports your exemption request before submitting.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4.6 Satisfied (57 Votes) |
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Related links
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