Statement of Immunization Exemption - Millersville University - millersville 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your M# in the designated field at the top of the form.
3. Fill in your full name and date of birth accurately to ensure proper identification.
4. Review the immunization requirements listed. Check the boxes next to DTP and MMR if applicable, indicating your compliance.
5. In the 'REASON FOR EXEMPTION' section, print your name clearly where indicated.
6. Select either 'Medical' or 'Religious' as your reason for exemption and provide a detailed written statement as required.
7. Sign and date the form at the bottom, acknowledging your understanding of the risks involved with not receiving vaccinations.
8. If available, attach any documentation from a medical provider that supports your exemption request before submitting.

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