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Governors State University Immunization Exemption Form 2016

Get Governors State University Immunization Exemption Form 2016

Irth (mm/dd/yyyy): GSU Student ID number: Phone number: Date of request: Reason for Request: Exemption* - Exclusively attend classes at an off-site location. Exemption* - Enrolled exclusively in an online degree program, or all online courses. Note: A new Exemption Form, signed by your advisor, must be submitted every semester on or before the current Immunization Deadline. *Advisor s Signature: Date: Student Signature: Date: Submit this form in person to Academic Resource Center, B121.

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