Fillable COVID-19 VACCINATION RELIGIOUS EXEMPTION REQUEST FORM Morgan State (Morgan State University)

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COVID-19 VACCINATION RELIGIOUS EXEMPTION REQUEST FORM Morgan State (Morgan State University)

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COVID-19 VACCINATION
RELIGIOUS EXEMPTION REQUEST FORM
Morgan State University is committed to building an inclusive, equitable and diverse campus community. If your
religious beliefs or practices conflict with the University’s vaccination requirement, please complete this form and
upload this to our secure Vaccination portal found on our www.morgan.edu/coronavirus site.
Confidentiality of Information Provided - Requests for exemptions and any other documents provided will be kept
confidential.
REQUESTOR
NAME
DATE OF BIRTH
EMAIL
PHONE NUMBER
BELOW FOR FACULTY AND STAFF ONLY
DEPARTMENT
TITLE
IMMEDIATE SUPERVISOR
SUPERVISOR’S PHONE#
Please explain in your own words why you are seeking a religious exemption. Please provide the religious
principles that guide your objection to immunization and indicate whether you are opposed to all immunizations,
and if not, the religious basis on which you object to COVID-19 immunizations.
The following certification may be required if there is an objective basis for questioning the religious nature of the
request. You may also secure the certification voluntarily as part of your submission regardless of whether it is
subsequently requested.
FOR RELIGIOUS/SPIRITUAL LEADER
I am a religious/spiritual leader at __________________________________________________ and hereby
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certify that the above information provided by _______________________ who is a member of my religious
organization is accurate and that this is a request for a religious exemption from the COVID-19 vaccine
requirement at Morgan State University.
Religious Leader Signature:_____________________________________ Date:___________________
Print Name:_________________________________ Religious Organization:__________________________
FOR THE REQUESTOR (Student/Faculty/Staff)
I verify that the above information I have provided is complete and accurate to the best of my knowledge, and I
understand that any intentional misrepresentation contained in this request may result in disciplinary action which
may include termination/dismissal (faculty/staff) and suspension/expulsion (students). My request for an
exemption from the COVID-19 vaccination requirement is based upon my religious beliefs. I understand that my
request for an exemption may not be granted if it is unreasonable or creates an undue hardship for the University.
Signature: ___________________________________________ Date: __________________________
Printed Name: ________________________________________
MSU ID: _____________________
Signature of Parent or Guardian (if under 18 years old) _____________________________________
Printed Name: __________________________ Date:____________________________
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COVID-19 VACCINATION RELIGIOUS EXEMPTION REQUEST FORM Morgan State (Morgan State University)

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Completed 5 August 2021

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