Religious exemption for vaccinations.pdf Google Drive
Va Religious Exemption Form. Web employees should provide this form to the rac. Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1.
Religious exemption for vaccinations.pdf Google Drive
Trainee, resident, intern, fee basis, or researcher) please indicate: Web form prior to submission to your supervisor. You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1. Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Rac will assign log number below for record keeping purposes. Fully vaccinated (required documentation attached): Received the seasonal influenza vaccine this flu season.
Web employees should provide this form to the rac. Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. Web form prior to submission to your supervisor. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval This form should be retained separately from the employee's official personnel folder. Please read the descriptions below to learn the criteria to request a medical or religious exception. The student or his parent or guardian submits a notarized certificate of religious exemption (form cre 1), to the admitting official of the school to which the student is seeking admission. Fully vaccinated (required documentation attached): Trainee, resident, intern, fee basis, or researcher) please indicate: Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health:
