SLAI Covid-19 Vaccination Exemption Request – Summer Liberal Arts Institute

Students may use this form to request an exemption from the vaccination requirement for COVID-19 due to a medical condition or a sincerely held religious belief.

Review of this request may take up to 2 weeks.

SLAI 2023 Covid-19 Vaccination Exemption Request

Student Name*
First Last
Student Email*
Student Birthdate*
Which SLAI program are you applying for this summer?*
- Building Connections in STEM
- Computer Science
- Fundamentals of Neuroscience
- Humanities
- Political Science
- Storytelling
All pre-college programs will take place from July 9 - 28, 2023.
Parent Name*
First Last
Parent Email*
Type of Exemption Request
Medical Exemption Request
Medical Condition*
Please describe the medical reason for your request.
Required Medical Documentation*
Max. file size: 100 MB.
Medical accommodation requests require supporting documentation from the medical provider most familiar with your condition.
Certification*
- I certify this information is true and accurate.
Religious Exemption Request
Religious Beliefs*
Describe your sincerely held religious beliefs and practices, which result in this request for a religious exemption.
Certification*
- I certify this information is true and accurate.
Email
This field is for validation purposes and should be left unchanged.
Name
This field is for validation purposes and should be left unchanged.

SLAI 2023 Covid-19 Vaccination Exemption Request

Medical Exemption Request

Religious Exemption Request