COVID-19 vaccine medical exemption request

  • To request a medical exemption from the COVID-19 vaccination:

    1. Please fill out this form.
    2. Download the medical provider form and have your medical provider complete it. Return that document to the Human Resources Department.
    These forms must be completed in full for the accommodation request to be processed. Forms completed solely by the employee will not be accepted.


  • DOWNLOAD THIS PDF DOCUMENT: Part 2 medical provider form
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