One Semester Immunization Waiver of Full-Time Restriction

I understand that my State of Tennessee Immunization Requirements are not complete. To qualify for this waiver you must be a new first time student who has received the first dose of Varicella (chicken pox) and the first dose of MMR (measles, mumps and rubella).

This immunization waiver is for:

Semester*

Year*

I will provide medical documentation of the second immunization(s) to Student/University Health Services (fax: 423-439-4560) prior to my NEXT SEMESTER REGISTRATION.

Failure to do this will prevent full-time enrollment. Full-time enrollment means 12 hours or more for undergraduate and 9 hours or more for graduate students.

Check immunization status in GoldLink to verify that proof has been received.

Log into GoldLink using your username and password.
Click the "My Student Info" tab.
Under the "Registration Tools" box, choose Immunization Status.

If necessary requirements are not met, the one semester waiver will not be approved.

Student Name*

First NameLast Name

E#*

E-mail*

Phone Number*

Area CodePhone Number

Date:*

MonthDayYearHourMinutesAM/PM Option

I certify that the information is correct and my E Number acts as my electronic signature.*

Questions regarding immunization requirements: contact University Health Center (423) 439-439-4225.
Questions regarding completing this waiver: contact Registration Help Desk (423) 439-5584.