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
Submit Your Medical Exception Request
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.
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.
COVID-19 Booster Declination
To submit a voluntary declination for the COVID-19 Booster, read the COVID-19 Booster Vaccine Declination Statement, then log into the Patient Portal. Select “Medical Clearances” and chose the “COVID-19” option. Click the green update button. Use the "Add Immunization" option and choose "COVID-19 Booster Declination" from the Add Immunization drop down list.
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.