Forms and Exemptions

Below are the most commons forms required by the Health Office. Please contact the Health Office if you have questions while completing or submitting forms


Religious and Medical Exemptions

Persons who hold religious beliefs based on the tenets of an organized religion that prohibits vaccinating its members will be exempt from PHL 2165. Students must submit a signed request for approval to the Health Office.


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.

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.