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IMMUNIZATION EXEMPTION REQUEST FORM

IMMUNIZATION EXEMPTION REQUEST FORM 2026

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The document is an Immunization Exemption Request Form that outlines the process for students to request exemptions from immunization requirements based on religious or medical reasons. It specifies the necessary documentation for each type of exemption, including a written statement for religious exemptions and a doctor's note for medical exemptions. The form also notes that exemptions are evaluated individually and that students with exemptions may be required to leave campus during contagious outbreaks.

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Click ‘Get Form’ to open the IMMUNIZATION EXEMPTION REQUEST FORM in the editor.
Begin by entering your last name and first name in the designated fields. Ensure that your information is accurate for proper identification.
Input your date of birth (DOB) in the format of month, day, and year. This is crucial for verifying your age and eligibility.
Provide your ID number, which can be either an A number or RUID, to help link your request to your student profile.
Select either 'MEDICAL REASON' or 'RELIGIOUS REASON' for your exemption request. If you choose medical, ensure you attach a statement from a physician detailing the contraindication and its validity period.
For religious exemptions, write a clear explanation of how vaccinations conflict with your sincere beliefs. This must be completed by you as the student.
Sign and date the form at the bottom. Make sure all signatures are completed before submission.

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