Vaccination exemption form

 

 

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Vaccination Exemption Form. Department: Supervisor: Name: Title: Medical: Medical exemptions to immunization are available to those who have medical. A sample form for an employee to request exemption from required vaccinations. Medical Certification for Vaccination Exemption. Employee Name: Anyone requesting an exemption must access, complete and upload the request forms through the Yale Vaccine Portal (the portal). Once completed and uploaded vaccination. A medical exemption may be granted upon receipt of a completed form (below) not more than 6 months old, signed and certified by a licensedUse this form if you would like to notify us of an individual's vaccination exemption due to a medical contraindication or natural immunity. COVID-19 Vaccination Exemption Request Form. Please complete this form and submit it to the Office for Institutional Diversity, accommodation@bc.edu.

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