Mercyhurst University

      Vaccination Exemption Request Form DO NOT DELETE

      To request an exemption from Mercyhurst University's vaccination policy (for MMR, Meningitis, or COVID-19), please submit this form. More information on the policy can be found on our Vaccination Policy webpage. If a requester is under the age of 18, their parent/guardian must complete their request. You will receive notification as to the status of your request once it has been reviewed by Health Center personnel. If you have any questions regarding this form, please contact The Vaccine Response Team at

      Note: To request an exemption, you must have a PDF or Word document ready to submit that fully describes the nature of your request.