Student Request for Religious or Reasons of Conscience Exemption
from COVID-19 Vaccine Form
UANET: Email: Phone:
SUBMIT COMPLETED FORM AND DOCUMENTS TO: covidexemptionSHS@uakron.edu
The University of Akron is committed to providing an inclusive and supportive environment for
all and recognizes true and genuine observance of faith as it pertains to the practice of
immunization. A religious or conscientious exemption may be granted if (i) the individual holds
sincere religious beliefs, practice, or observance that are contrary to the practice of vaccination
or holds a sincere moral or philosophical conviction, such as the conviction that health and
disease should not be controlled by vaccination, (ii) completes this form, and (iii) provides the
required documentation to support the exemption request.
If approved, the exemption will remain in effect for the duration of the current academic year.
Individuals with approved exemptions may request to recertify exemptions each year. Individuals
with an approved exemption may be required to comply with COVID-19 testing and other
preventive health and safety measures.
Your requests will be carefully reviewed, although approval is not guaranteed. After your request
has been reviewed and processed, you will be notified, in writing, if an exemption has been
granted or denied. The decisions are final and not subject to appeal. Individuals are permitted to
reapply if new documentation and information should become available.
In order to submit a request, please:
● Read the CDC COVID-19 Vaccine Information CDC COVID-19 Vaccine Information;
● Complete and sign this form;
● Complete and sign the Personal Statement Form; and
● Submit the completed documents.
Incomplete submissions will not be reviewed. Be sure all forms and documentation are
submitted at one time.