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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 MMR, Varicella, Tdap, or Meningococcal conjugate vaccines will need their provider to complete this form.

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

Medical exemption requests are reviewed by the Medical Director and updated manually by Ashe Staff in the Medical Clearances section. You will only hear back from Ashe if your exception is NOT approved.

Religious Exceptions

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

Influenza Form

Influenza (Flu) Vaccine Religious Exemption Form

COVID-19 Form

COVID-19 Vaccine Religious Exemption Form