Office of the Registrar
Meningitis Vaccination Online Only Exemption Form
8/18/2020
OFFICE OF THE REGISTRAR
MSC 105, 1050 W. SANTA GERTRUDIS AVE
KINGSVILLE, TEXAS 78363-
PH (361) 593-2811 * FAX (361) 593-
MENINGITIS VACCINATION ONLINE ONLY EXEMPTION FORM
STUDENT NAME
: __________________________________________________________________________________________________
TAMUK ID: K__________________________________ TERM: __________________ 20__________
EMAIL: _________________________________________________________________ PHONE #: (______) ______-____________
Please indicate all courses you intend to register for:
I acknow
ledge by signing this form that I have been informed that:
• My course schedule will be monitored and
• Should I register for any course that is not
online only, I will be dropped from that course and a hold will
be placed on my record for the meningitis vaccination.
• I understand that any changes may affect my financial aid.
• I have to fill out this form for each semester that I intend to take classes, as this is only
for the semester
stated above.
____________________________
________________________________________________ ____________________________
Signature of Student Date
Please email the completed form as a PDF to registrar@tamuk.edu. Confirmation will be sent to the email
address indicated above.
TO BE COMPLETED BY TAMUK OFFICE OF THE REGISTRAR STAFF ONLY
Approved Denied
TAMUK Registrar Signature: ______________________________________________ Date: ______________________________
A copy of this document will be provided to the student and placed in the student’s file.
example: English
Rhetoric & Composition ENGL 1301 600 12416
