Forms and Exemptions

All new students should submit a Health Office Student Immunization Record before the start of classes.   

If you would like the Health Office to release your immunization records to another school, or if you would like to give SUNY CCC permission to obtain your records for you,  please submit the Health Office Release of Information Authorization.


Religious and Medical Exemptions


Students who hold genuine religious beliefs against being immunized will be exempt from PHL 2165 after submitting a request that has been approved by the college.  Religious exemption waiver requests must be submitted to the Health Office.   Please read the instructions on the form carefully before submitting your request.  In the event of an outbreak, students may be excluded from classes or campus.  

Medical Exemption

If a licensed physician or nurse practitioner, or licensed midwife caring for a pregnant student certifies in writing that the student has a health condition which is a valid contraindication to receiving a specific vaccine, then a permanent or temporary exemption may be granted. This statement must specify those immunizations which may be detrimental and the length of time they may be detrimental.  In the event of an outbreak, medically exempt individuals should be protected from exposure. This may include exclusion from classes or campus. Medical exemption waiver requests must be submitted to the Health Office.