Medical Exemption Form Winter 2022
(See Vaccine Requirements for more information)
As of June 2021, student vaccination requirements for BYU–Hawaii include:
Completed series of a World Health Organization-authorized COVID-19 vaccine required to be fully vaccinated against COVID-19.
Students should, whenever possible, receive the COVID-19 vaccine before coming to campus. BYUH Health Services will facilitate COVID-19 vaccinations for students who are unable to be immunized before arriving on campus.
You must submit the BYUH Health Immunization Requirements Form to document your completed COVID-19 vaccine information.
For more information and answers to frequently asked questions about this announcement and COVID-19 vaccinations, go to the COVID-19 Vaccine Frequently Asked Questions page.
State of Hawaii
- Two doses of Measles with at least one dose being an MMR-Measles/Mumps/Rubella (at least four weeks apart).
- Two doses of Varicella (Varivax) (at least 4 weeks apart).
- One dose of MCV (Meningococcal Conjugate) taken at age 16 or later.
One dose of TDAP (Tetanus/Diphtheria/Pertussis) at age 11 or later, AND proof of a primary series of DPT.
Those who have never been vaccinated against Tetanus, Diphtheria or Pertussis or do not have documentation should receive a series of three vaccinations: Tdap, followed by a dose of Td at least four weeks after the first Tdap, and another dose of Td at least six months after the previous Td. A single dose of Tdap can substitute for any of the Td doses in the 3 dose series.
A titer (blood test) proving immunity to any of the diseases addressed by the State of Hawaii-mandated vaccinations is acceptable. A copy of the laboratory report must be provided.
You may have your physician complete the State of Hawaii Health Immunization Requirements form to document your MMR, Varicella, MCV, and Tdap vaccine information. These vaccines are usually available at your physician's office or your local health department. BYUH Health Services offers these vaccines for a fee.
The DOH also requires tuberculosis (TB) clearance before class attendance. You may get a TB skin test upon arrival at BYU–Hawaii or at your physician's office, PROVIDED ALL CRITERIA on the Tuberculosis Clearance Form are met. If you are planning to get your TB test at BYU–Hawaii, please do not get an MMR or Varicella vaccine less than 30 days prior to arriving on campus.
Once your completed immunization record has been received and approved, you will be able to proceed with your registration. Failure to complete your state health immunizations or provide the necessary information to the Health Center may delay your registration or approval to attend class. If you have not taken all of your required vaccines, please send in or email your vaccination record to Health Services so that we can let you know if any vaccines are still needed.
Former students who are returning to school may call or email Health Services to check on your state health immunization status.
If your country does not provide the required vaccines, please have your physician complete the bottom section of the State Health Requirements form. The student should complete section F and circle those vaccines not available in their country and sign that portion of the form.
Medical or Religious Exemptions
Hawaii state health laws provide immunization exemptions for bonafide religious or medical reasons only. Exemptions can only be applied to the vaccine requirement and NOT tuberculosis clearance. If at any time there is, in the opinion of the State’s department of health, danger of an epidemic from any of the communicable diseases for which immunization is required by the State, students with exemptions, if not immunized, will be excluded from attending classes or other campus activities until the epidemic has cleared.
- A medical exemption may be granted to SPECIFIC VACCINES.
- A U.S. licensed physician (MD or DO) must state in writing that receiving a specific vaccine would endanger the individual's life or health, and specify the reason based on valid medical contraindications.
- The physician must state the length of time during which the vaccine would endanger the individual's health or life.
- The exemption request must be signed by the physician on the physician's printed stationery.
- For vaccines required by the State of Hawaii, a completed Medical Exemption Form must be turned in to BYUH Health Services. To update a submitted form, please contact Health Services. Exemptions for a COVID-19 vaccination do not require a form. See steps one through four above.
A religious exemption may be granted provided the criteria on the Religious Exemption Form are met. A request for religious exemption based on objections to specific vaccines will not be granted.
Exemptions requests and related documentation should be sent to BYUH Health Services at email@example.com.