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GOVERNORS STATE UNIVERSITY IMMUNIZATION DEADLINE EXTENSION/EXEMPTION REQUEST FORM Name (last, first, middle) Birth Date (mm/dd/by) CSU ID # Address City / State ZIP Code Phone Cell Alternate Check

How to fill out immunization deadline extensionexemption request

How to Fill out Immunization Deadline Extension/Exemption Request:

1. Gather necessary information: Before starting to fill out the immunization deadline extension/exemption request, gather all the relevant information, such as the name, date of birth, and contact details of the individual seeking the extension or exemption. Also, make sure to have any relevant medical records or documentation ready.
2. Identify the reason for the request: The immunization deadline extension/exemption request typically requires you to specify the reason for the request. Determine whether you are seeking an extension due to exceptional circumstances or if you are requesting an exemption based on personal or religious beliefs. Be prepared to provide supporting documentation or a detailed explanation for your request.
3. Follow the provided format: The request form may provide specific sections or fields to fill out, such as personal details, vaccination history, and the reason for the extension/exemption request. Fill out each section accurately and thoroughly, ensuring that the provided format is followed correctly.
4. Attach any necessary documentation: If you are seeking an extension or exemption based on medical reasons, it is important to attach any relevant medical records or documentation supporting your request. This may include letters from healthcare professionals or specialists explaining the medical condition or contraindication.
5. Review and double-check: Before submitting the request, carefully review each section to ensure that all required information has been provided accurately and completely. Double-check for any missing or incomplete details and make any necessary corrections.

Who Needs Immunization Deadline Extension/Exemption Request:

1. Students and parents: Students who are unable to meet the immunization deadline set by educational institutions may need to submit an extension/exemption request. This could be due to various reasons such as medical conditions, alternative vaccination schedules, or religious or personal beliefs that prevent vaccination.
2. Healthcare providers: In some cases, healthcare providers may need to request an immunization deadline extension or exemption for their patients. This could be necessary if there are medical contraindications or if the patient's immunization status needs further evaluation.
3. Individuals with exceptional circumstances: People who have faced exceptional circumstances, such as natural disasters, emergencies, or unforeseen events, may require an extension in their immunization deadline. These circumstances could hinder their ability to adhere to vaccination schedules, making a request necessary.

Remember, the specific requirements and procedures for filling out an immunization deadline extension/exemption request may vary depending on the institution or jurisdiction. It is essential to carefully follow the instructions provided by the relevant authorities while submitting the request.

For pdfFiller’s FAQs

What is immunization deadline extension/exemption request?

Immunization deadline extension/exemption request is a request submitted to extend the deadline or request an exemption from the required immunization deadline for certain individuals.

Who is required to file immunization deadline extension/exemption request?

Individuals who are unable to meet the immunization deadline due to certain circumstances or individuals seeking an exemption from the immunization requirements are required to file the request.

How to fill out immunization deadline extension/exemption request?

The request can typically be filled out by providing personal information, reasons for requesting an extension/exemption, and any supporting documentation as required.

What is the purpose of immunization deadline extension/exemption request?

The purpose is to allow individuals to request an extension of the immunization deadline or to seek an exemption from the immunization requirements based on specific circumstances.

What information must be reported on immunization deadline extension/exemption request?

The request usually requires personal information, reasons for requesting an extension/exemption, and any supporting documentation as necessary.

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