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Exemption or Declination from UC's Immunization Requirements

Overview

MEDICAL EXEMPTION may be considered for students with medical conditions which may be contraindications for the following required vaccines:

       * MMR 

       * Varicella

       * Tetanus/Pertussis

       * Meningococcal ACWY

DECLINATION may be submitted for the following vaccines, without the need for a Medical Exemption request:

       * COVID-19

       * Influenza

REMOTE LEARNING forms may be submitted for students who are currently off campus for their studies and will not be on campus for any reason.

Students seeking an Exemption, Declination, or Remote Learning request must submit a request via the Student Health Patient Portal no later than their appropriate compliance deadline dates. Please follow the directions for completion and submission below.

 

If you intend to submit a request, please click on the form below that corresponds to the specific exemption or declination that you are requesting. The submission of a request is completed online via the Student Health Patient Portal.

Overview of the process:

  1. Download the fillable request form. Links to the forms appear below on this webpage and they are also available on the Student Health Patient Portal.
  2. Complete and sign the applicable form.
    * Note that the medical exemption form must be completed and signed by an approved health care provider.
  3. Upload the completed form to the Student Health Patient Portal for appropriate review and processing.

Review of Exemption/Declination Requests

  1. Medical/Disability Exemptions will be reviewed by the SHC Medical Director.
  2. Religious Exceptions will be reviewed by UCI Religious Exceptions Committee.
  3. Declinations will be AUTO-APPROVED if all information is entered correctly.
  4. Remote Learning requests will be reviewed and confirmed with Registrar.

Questions?

 * For questions regarding the exemptions process, please send a secure message on the Student Health Patient Portal to "Immunization Exemption/Deferral Request Inquiry". A SHC nurse will respond to your inquiry within 3-5 business days.

 

The form below is to be used to request a Medical/Disability Exemption.

  1. Download the form
  2. Present to your Personal Healthcare Provider to complete, Date and Sign
  3. Upload the form through the Student Health Portal
PDF icon UCI Medical/Disability Exemption Request Form
 

PLEASE NOTE: The Medical Board of California has stated that a physician who grants a vaccine MEDICAL EXEMPTION without conducting an appropriate prior exam and without a finding of a legitimate medical reason supporting such an exemption within the standard of care may be subjecting their license to disciplinary action.

The Medical Board of California encourages the public to REPORT such providers to the Board if they feel that a physician is granting exemptions inappropriately.

The form below is to be used to request a Religious Exception.
1. Download the form (also available in the Student Health Portal)

    a.PDF iconUCI Religious Exception Request Form 

 

2. Carefully read the form and answer the questions as completely as possible on the form, then date and sign the form.

           IMPORTANT: Please fill in all the sections of the form (Question 3 is optional; all of the other questions and boxes are required).

           UCI will rely on what you submit in making its determination on your request.

3. Upload the form through the Student Health Portal:

    a. Click on “Upload Images/Clearance Forms”
    b. Find the “Religious Exception” section of the Downloadable Forms page
    c. Click “Upload” and attach your completed request form
    d. Click “SAVE” at the BOTTOM or all work will be lost

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PLEASE NOTE: While your request is pending you must comply with any and all applicable non-pharmaceutical (i.e., behavioral) interventions (i.e., masking or distancing) and vaccine education as specified by UCI or applicable public health directives as a condition of your Physical Presence at any University Location/Facility or Program.

In the event of a disease outbreak, you may be excluded from the site of the outbreak or subject to additional Non-Pharmaceutical Interventions or Vaccine Education in order to protect the health and safety of yourself and others.

The form below is to be used to request a Remote Learning extension.
1. Download the form
2. Complete, Date and Sign
3. Upload the form through the Student Health Portal

  UCI Remote Learning Form

* For students who are currently doing coursework remotely and will not be back on campus for any reason, including work or meetings.
* The list of enrolled courses is required and confirmation may be requested by the Registrar or Academic Department.
* Once a student returns to UCI for on-site learning, requirements will be reinstated, and non-compliant students may have their registrations held.
* New forms must be submitted for each quarter while remote.

The form below is to be used to request a COVID-19 Declination.

  1. Download the form
  2. Complete, Date and Sign
  3. Upload the form through the Student Health Portal
PDF icon COVID Vaccination Declination Letter

The form below is to be used to request a Flu Vaccination Declination.

  1. Download the form
  2. Complete, Date and Sign
  3. Upload the form through the Student Health Portal

PDF iconUC Flu Vaccination Declination Letter