COVID-19 Vaccination Exemption Request

Exemption Request Form for COVID-19 Vaccination

**** Students registered for online courses only will be waived from the COVID-19 vaccine requirement once this form has been completed, sent, and confirmed by the Health Center.

If you see this don't fill out this input box.

First Name*

Last Name*

Student Email Address*

Current Semester*

M#*

This form is required for students requesting an exemption from the COVID-19 vaccination requirement due to their status as a student registered only for online courses.

I understand that all Mohawk Valley Community College students who access any SUNY campus facilities in person are to be fully vaccinated against COVID-19.
My name and M# below indicates that I am requesting an exemption from this requirement beginning on the date this form is signed, and that I attest I am registered for online courses only and will not have a physical presence at any SUNY facility, including for the purpose of using on-campus services, for the duration of the identified semester.
I understand that if I want to register for only online courses again during a subsequent semester, I will need to request a new waiver.
Furthermore, I attest that if I must have an in-person presence at any SUNY facility after signing this form, that I will submit proof of COVID-19 vaccination to the Health Center.
I have read and understood the foregoing statements and sign it with full knowledge of its meaning and content.

E-Signature*

Date*