Immunization Waiver

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University Registrar

102-A Burgin E. Dossett Hall Box 70561
423-439-6744

Immunization One-time Waiver (Full-time) or Immunization Waiver for Online Classes ONLY

Questions regarding immunization requirements: contact University Health Center (423) 439-439-4225.
Questions regarding completing this waiver: contact Registration Help Desk (423) 439-5584.

What Immunization Waiver are you requesting?

Immunization One-time Waiver (Full-time)

I understand that my State of Tennessee Immunization Requirements are not complete. To qualify for this waiver you must be a new first time student who has received the first dose of Varicella (chicken pox) and the first dose of MMR (measles, mumps and rubella).

I will provide medical documentation of the second immunization(s) to Student/University Health Services (fax: 423-439-4560) prior to my NEXT SEMESTER REGISTRATION.

Failure to do this will prevent full-time enrollment. Full-time enrollment means 12 hours or more for undergraduate and 9 hours or more for graduate students.

Check immunization status in GoldLink to verify that proof has been received.

Log into GoldLink using your username and password.
Click the "My Student Info" tab.
Under the "Registration Tools" box, choose Immunization Status.

If necessary requirements are not met, the one semester waiver will not be approved.

This immunization waiver is for:

Semester

Year

Student Name

Phone #

Date

I certify that the information is correct and my E Number acts as my electronic signature.

Immunization Waiver for Online Classes ONLY

In submitting this form, I affirm that I am registering for ONLY online classes

I understand, for each semester for which I am requesting the exemption, I must complete a new form, sign and either submit online, fax, or bring it to the Registration Office in order to continue to be exempt from the immunization requirements related to full-time enrollment.