Va Religious Exemption Form

Va Religious Exemption Form - Web form prior to submission to your supervisor. 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. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. This form should be retained separately from the employee's official personnel folder. Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Trainee, resident, intern, fee basis, or researcher) please indicate: Received the seasonal influenza vaccine this flu season. Please read the descriptions below to learn the criteria to request a medical or religious exception.

I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. Received the seasonal influenza vaccine this flu season. 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. Web employees should provide this form to the rac. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. This form should be retained separately from the employee's official personnel folder. Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval 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: Please read the descriptions below to learn the criteria to request a medical or religious exception. Web form prior to submission to your supervisor. Fully vaccinated (required documentation attached): Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. 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. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered.

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

Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. Web form prior to submission to your supervisor. 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. Trainee, resident, intern, fee basis, or researcher) please indicate: Fully vaccinated (required documentation attached):

Web Commonwealth Of Virginia Certificate Of Religious Exemption Name ____________________________________ Birth Date _______________________ Student I.d.

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: This form should be retained separately from the employee's official personnel folder. Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or.

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.

Rac will assign log number below for record keeping purposes.

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