Va Religious Exemption Form

Va Religious Exemption Form - 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 Trainee, resident, intern, fee basis, or researcher) please indicate: 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. 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. Rac will assign log number below for record keeping purposes. This form should be retained separately from the employee's official personnel folder. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health:

Web form prior to submission to your supervisor. Received the seasonal influenza vaccine this flu season. Rac will assign log number below for record keeping purposes. Fully vaccinated (required documentation attached): 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. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: 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: 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.

Rac will assign log number below for record keeping purposes. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. Fully vaccinated (required documentation attached): Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Web form prior to submission to your supervisor. Web employees should provide this form to the rac. Trainee, resident, intern, fee basis, or researcher) please indicate: This form should be retained separately from the employee's official personnel folder. 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.

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Fully Vaccinated (Required Documentation Attached):

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. Rac will assign log number below for record keeping purposes. Web employees should provide this form to the rac.

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

Trainee, resident, intern, fee basis, or researcher) please indicate: You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. 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.

This Form Should Be Retained Separately From The Employee's Official Personnel Folder.

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. 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. 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:

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