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Please communicate with your school/program to better understand the clinical site's process, and which form to complete. Some sites reviewing and deciding exemptions have developed their own forms for students to submit directly to them. Some KU Medical Center partners are administering their own religious exemption request processes while other sites are directing KU Medical Center to perform that review. If the clinical site you are assigned to is administering the exemption review process, you may not need to complete or submit any forms to KU Medical Center, unless otherwise directed by the site. KU Medical Center clinical partners are now requiring all students to have received the COVID vaccine before being allowed to begin or continue their clinical or programmatic experiences. Student Vaccination Religious Exemption Request Form COVID Vaccine Exemption Request Student Vaccination Medical Exemption Request Form Please complete the form below to request a medical or religious exemption for a required vaccination (Measles, Mumps, Rubella, Hepatitis B, Influenza, varicella, Tdap Tetanus, Diphtheria, Pertussis). You will need to upload the completed form in order to submit your request. After the request has been thoroughly reviewed, you will be notified, in writing, of the decision regarding your requested religious exemption.If you are completing a medical exemption form for a required vaccination or a Covid-19 vaccine, please make sure to take the medical attestation form to a licensed independent provider (MD, DO, APRN) to complete the attestation. Once you submit the form below, a member of OED will carefully review your request. As part of this commitment, the University makes every effort to accommodate religious observances and practices in accordance with our Notice of Nondiscrimination and Affirmative Action Policy, unless it creates an undue hardship for the University. Employee COVID-19 Vaccine Medical Exemptionįor employees seeking a medical exemption to the COVID-19 Vaccine, please complete the Office of Prospective Health form.ĬOVID-19 Vaccination Medical Exemption Form (PDF)Įast Carolina University is committed to diversity, inclusiveness, and nondiscrimination in support of its learners and employees. If you feel this decision violates your civil rights, you may file a complaint with the Equal Employment Opportunity Commission. This decision is final and not subject to appeal.
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If your request for a religious exemption is denied, it may be reconsidered only if new information supporting your request is provided. In requesting an exemption to the vaccination requirement, you agree to comply with these restrictions. In the event of a COVID-19 outbreak or cluster on campus, individuals with exemptions may be temporarily excluded from campus activities or reassigned until the outbreak is declared to be over. If you are granted a religious exemption, you will be required to undergo COVID-19 testing and observe all other COVID-19 health and safety protocols as required by the University. After the request has been thoroughly reviewed, you will be notified, in writing, of the decision regarding your requested religious exemption. The Office for Equity and Diversity (OED) will carefully review all requests for religious exemptions however, exemptions to the vaccine requirement are not guaranteed. General philosophical reluctance will not provide enough basis for an exception to the vaccination requirements. A written and signed statement from your religious leader supporting the basis for your request against the COVID-19 vaccination may be required. Your religious exemption must include a statement in your own words regarding the grounds for the requested religious exemption and the specific religious principles that guide your objection to immunization. Submit any required documentation to support the exemption request.Complete the appropriate form to request an exemption and.Hold a sincere religious belief which is contrary to the practice of vaccination(s).A religious exemption may be granted if you: If you object to the COVID-19 vaccination, or any immunization, because it conflicts with your sincerely held religious beliefs and practices, you may apply for a religious exemption. East Carolina University is committed to diversity, inclusiveness, and nondiscrimination in support of its learners and employees.