Submit ONLY if you are requesting an exemption to the UI immunization requirement, because of a medical condition or religious belief. Students aged 18 and over must complete and sign their own religious exemption form, including having it notarized.

Iowa Department of Public Health Medical Exemption Form

Iowa Department of Public Health Religious Exemption Form

  • If you have an official, valid religious or medical exemption form (must be current, not from childhood, signed by the student if over age 18), do not submit this through Med+Proctor, as they will not process it. Email your official form to