COVID-19 Vaccine Accommodation Requests
COVID-19 Vaccine Medical/Disability Accommodation Request Forms
Please read carefully below to select the correct form and submission process.
Centers for Medicare & Medicaid Services (CMS) clinical/practicum experiences
Download the form for CMS clinical/practicum experiences.
Who should use this form: This form is for Penn State graduate, medical, and undergraduate students who must complete clinical/practicum experiences in agencies and sites that bill patients under Medicare and Medicaid.
How to submit this form: Students should submit the form to University Health Services by logging into myUHS and uploading an image of the completed COVID-19 Vaccination Requirement Medical/Disability Accommodation Request.
Graduate assistantships
Download the form for students supported on graduate assistantships.
Who should use this form: Penn State students supported on graduate assistantships.
How to submit: Students should submit the form to University Health Services by logging into myUHS and uploading an image of the completed COVID-19 Vaccination Requirement Medical/Disability Accommodation Request.