Fillable Immunization Exemption 1 - Immunization Exemption

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Immunization Exemption 1 - Immunization Exemption

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Tennessee Tech | Office of the Registrar | Jere Whitson Building, Room 221 | 931.372.3317 | registrar@tntech.edu | tntech.edu/em/records/
Office of the Registrar
TENNESSEE TECH
Student Name: _____________________________________________ T#: _______________ Term: ___________
(Last) (First) (MI)
Students who are enrolled in ONLY online classes, including TTU online and TN eCampus (formerly RODP) courses, are
exempt from immunization requirements. To request this exemption, complete this form and fax, scan/email, mail, or
deliver to the Office of the Registrar. This form must be completed each semester for which the exemption is being
requested.
I affirm that I am only registered for online courses at TTU during the semester as stated above. I understand that I will
need to complete a new form each semester to continue to be exempt from all the immunization requirements that are
related to full-time enrollment.
Student Signature: _______________________________________ Date: ________________
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Immunization Exemption 1 - Immunization Exemption

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Completed 9 March 2020

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