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For coronavirus information for the UCLA community, please visit the Ashe Center website and UCLA’s information page.

UCLA Immunization Requirement

Medical Exceptions

Students with a medical condition having a contraindication to the COVID-19, Influenza, MMR, Varicella, Tdap, or Meningococcal conjugate vaccines will need their provider to complete this form. This includes students with a recent COVID-19 diagnosis/treatment who have been advised by their clinician to delay the booster vaccine for more than 3 months and need a temporary exception.

Medical Exception Request Form

Download Form

Submit Your Medical Exception Request

Log in to The Ashe Center Patient Portal to submit

Once the form is completed, log into the Patient Portal. Select “Messages” and chose the “Immunization Requirement Question” option. In the body of the message, indicate that you are requesting a Medical Exception and upload your completed medical exemption form by using the “Add attachment...” feature.

Note: Medical exception requests are reviewed by the Medical Director and updated manually by Ashe Center Staff in the Medical Clearances section. Please allow up to 4 weeks for processing requests.

Religious Exceptions

To submit a request for religious exception or accommodation, log into the Patient Portal. Select “Messages” and chose the “Immunization Requirement Question” option. In the body of the message, indicate that you are requesting a Religious Exception and upload your completed religious exception form by using the “Add attachment...” feature.

Log in to The Ashe Center Patient Portal to submit your Religious Exception request

Influenza Form

Influenza (Flu) Vaccine Religious Exception Form

COVID-19 Form

COVID-19 Vaccine Religious Exception Form

Program Exceptions

Students who are a part of the following self-supporting programs do not have access to The Ashe Center, including the Patient Portal. With the exception of the COVID-19 vaccine, they are NOT subject to the other immunization requirements:

  • EMBA (Executive MBA)
  • GEMBA (Global Executive MBA)
  • ELP (Education Leadership Program)
  • MPHHP (Master of Public Health for Health Professionals)
  • MSE (Master of Science Engineering)

Students in the above programs must submit their COVID-19 vaccine requirements through the UCLA COVID-19 Symptom Monitoring and Vaccination Verification System.

All other incoming students from all remaining programs are subject to the full immunization requirements.