Va Religious Exemption Form

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

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You May Select Medical Exception, Religious Exception, Or Select Both If You Meet The Criteria For Both A Medical And Religious Exception.

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. Please read the descriptions below to learn the criteria to request a medical or religious exception. Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval

Fully Vaccinated (Required Documentation Attached):

Received the seasonal influenza vaccine this flu season. Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Rac will assign log number below for record keeping purposes.

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. 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. Trainee, resident, intern, fee basis, or researcher) please indicate:

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

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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