COVID Fully Remote Instruction Mode Exemption Form

Students who are enrolled in the fully remote instruction mode may be granted a waiver from the COVID-19 vaccine requirement. 

The Fully Remote Instruction Student Exemption is term-based.  A student registering for fully remote courses during a subsequent semester must submit a new Fully Remote Instruction Exemption Request Form to Health Services.  If approved, a “COVID-19 Approved Remote EXMTN” (CVR) hold will be added to the requested semester allowing enrollment in fully remote courses for that term only.  A “Missing COVID-19 Vaccine Proof” (CVD) hold will remain on the record, preventing enrollment in future terms. 

If you are approved for a Covid-19 Vaccine Fully Remote Instruction Exemption Request, you will be automatically dropped from any classes you are registered for that have an in-person component including hybrid instructional mode courses. Students registered in an online degree program are automatically excluded from the requirement and do not need to complete the request form.

List of approved online academic programs

Exemption Process

Students requesting an exemption due to fully remote registration status are required to submit a completed and signed COVID-19 Vaccine Fully Remote Instruction Exemption Request Form to UB Health Services. Students must reapply for the exemption on a per semester basis. 

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University at Buffalo
4350 Maple Rd
Amherst, NY 14226

Phone: (716) 829-3316; Fax: (716) 829-2564

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: 3/24/2022

Owner: Student Health Services