The purpose of this form is to help Milligan University (MU) determine your eligibility for a religious exception to the COVID-19 Vaccination Requirement as mandated by the federal government through the Centers for Medicare and Medicaid Services (CMS).

To apply for a religious exception to the COVID-19 vaccination requirement, please follow these instructions:

1. Answer the questions asked at the end of this form as clearly and concisely as you can.
2. Sign this form by printing your name in the “Print Name” field below. Submission of your name in this field will constitute your legal signature.
3. Submit the completed form by clicking the “Submit” button at the end of this form. Your application will be reviewed by the University, and you will receive written notification of the acceptance or rejection of your application within 72 hours of the deadline set forth by your academic program.

You do not need to answer every question on the form to be considered for a religious exception. But we encourage you to provide as much information as possible to enable MU to evaluate your application. In some cases, we may ask you for follow-up information in determining eligibility for an exception. Nevertheless, it is up to you to provide information initially that is clear, complete, and accurate so that MU can make an informed decision about your application without asking for additional information.

MU may consider several factors in assessing whether a request for an exception is based on a sincerely held religious belief, including whether the applicant has acted in a manner inconsistent with his/her professed belief. But no one factor is determinative. An individual’s beliefs or degree of adherence to those beliefs may change over time. We recognize that an applicant’s newly-adopted or inconsistently-observed practices may nevertheless be based on a sincerely held religious belief. Still, the burden is upon the applicant to make clear how his/her request for a religious exception is justifiable given the applicant’s religious convictions and actions. All applications for a religious exception will be evaluated on an individual basis. Objections to COVID-19 vaccination that are based on non-religious reasons, including personal preferences or non-religious concerns about the vaccine, do not qualify for a religious exception.

Signing this form constitutes a declaration that the information you provide is true and correct to the best of your knowledge and ability. Any intentional misrepresentation to MU may result in automatic denial of your application for an exception.

Please answer the following questions in the text box below:

1. Please describe the nature of your objection to the COVID-19 vaccination requirement.
2. Would complying with the COVID-19 vaccination requirement substantially burden your religious exercise or conflict with your sincerely held religious beliefs, practices, or observances? If so, please explain how.
3. Please provide any additional information that you think may be helpful in reviewing your request. For example:
1. How long have you held the religious belief underlying your objection to receiving the vaccine?
2. Do you hold a religious objection to the use of all vaccines, only COVID-19 vaccines, a specific type of COVID-19 vaccine, or some other subset of vaccines?
3. Have you received vaccines as an adult against any other diseases (such as a flu, tetanus, etc.)?