• Immunization Affidavit - Religious Beliefs Exemption Request


  • Students

    SAN JOSE EVERGREEN COMMUNITY COLLEGE DISTRICT (SJECCD) RELIGIOUS BELIEFS EXEMPTION:

    SJECCD will consider sincerely held religious beliefs exemptions to the COVID-19 vaccine requirement on a case-by-case basis. 

    Religious beliefs exemptions require a signed written statement from the student describing the reason for the exemption and must include the information below.  Any student granted a religious exemption acccommodation may be required to submit to mandatory weekly COVID-19 testing.

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  • If you agree to the conditions of this immunization affidavit, please sign below with Adobe Sign:

  • Please have your parent/guardian complete the following part and sign below with Adobe Sign:

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