Va Religious Exemption Form

Va Religious Exemption Form - The student or his parent or guardian submits a notarized certificate of religious exemption (form cre 1), to the admitting official of the school to which the student is seeking admission. Received the seasonal influenza vaccine this flu season. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. Web employees should provide this form to the rac. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Fully vaccinated (required documentation attached): Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1. Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Trainee, resident, intern, fee basis, or researcher) please indicate:

Fully vaccinated (required documentation attached): Web form prior to submission to your supervisor. Web employees should provide this form to the rac. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Received the seasonal influenza vaccine this flu season. You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health:

Web employees should provide this form to the rac. Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1. Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. Please read the descriptions below to learn the criteria to request a medical or religious exception. The student or his parent or guardian submits a notarized certificate of religious exemption (form cre 1), to the admitting official of the school to which the student is seeking admission. Trainee, resident, intern, fee basis, or researcher) please indicate:

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Please Read The Descriptions Below To Learn The Criteria To Request A Medical Or Religious Exception.

Rac will assign log number below for record keeping purposes. Fully vaccinated (required documentation attached): This form should be retained separately from the employee's official personnel folder. Trainee, resident, intern, fee basis, or researcher) please indicate:

Form Cre 1 Is An Affidavit Stating That The Administration Of Immunizing Agents Conflicts With The Student's Religious Tenets Or Practices.

I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. The student or his parent or guardian submits a notarized certificate of religious exemption (form cre 1), to the admitting official of the school to which the student is seeking admission.

Regarding Religious Requests, Approvals Will Be Annotated On Va Form 10230B And Written Notice Of The Approval

Received the seasonal influenza vaccine this flu season. Web form prior to submission to your supervisor. Web employees should provide this form to the rac. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health:

Web Regarding Disability Requests, Approvals Will Be Annotated On Both The Va Form 10230A And Va Form 0857F, Accommodation Request Determination, In Accordance With Va Handbook 5975.1.

Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d.

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