Follow the steps to complete the immunization exemption form

1. Press the ‘Get Form’ button to access the Statement Of Immunization Exemption, allowing you to view and complete the document online.
2. Fill in the M# field with your assigned Millersville University identification number to help the university track your exemption request accurately.
3. In the Name field, enter your full name as it appears in official university records to ensure proper identification.
4. Add your date of birth in the allotted field to verify your identity and age, as this may be relevant for the exemption process.
5. Review the immunization requirements listed on the form, noting the DTP and MMR vaccines that are typically required for attendance at the university.
6. Select the appropriate checkboxes to indicate your request for an exemption, whether for medical or religious reasons, as permitted under PA Code 288 23.84.
7. In the Reason for Exemption section, print the name of the individual seeking the exemption in the space provided to clarify for whom the exemption is being requested.
8. Provide a written statement for medical exemptions, if applicable, detailing why the immunization may be detrimental to your health.
9. For religious exemptions, include a written statement that explains your moral or ethical convictions related to vaccination.
10. Sign the form to acknowledge your understanding of the risks associated with not receiving the required immunizations.
11. Enter the date of your signature in the designated field to document the completion of your exemption request.
12. Finally, review your completed form for accuracy and save any changes made. You can then download, print, or share the form as needed.

Take the next step towards your immunization exemption by completing and submitting the form online.