Log in to Lesley.Medicatconnect.com to download the Lesley University Exemption Request Form.
Medical Exemption Requests – have your physician complete a section of the Exemption Request Form attesting that a specific immunization is medically contraindicated. The name of the vaccine that is medically contraindicated and the reason for the contraindication must be included.
Religious Exemption Requests– submit a written personal statement explaining in detail how immunizations conflict with your sincere religious beliefs. Sign and date your statement.
Complete your section of the form, check all the required boxes, sign and date the form.
Upload completed forms and documentation of any prior immunizations to Lesley.Medicatconnect.com.
Prior childhood or adult immunization records or titers must also be uploaded.
A titer is a blood (serologic) test, which demonstrates the level of immunity to measles, mumps, rubella; chickenpox; and hepatitis B and may be submitted as an alternate if you’re unable to locate your immunization records.
There is no test to prove immunity to tetanus, diphtheria, and pertussis (whooping cough), so you’ll need to have a Tdap to fulfill the Massachusetts State Immunization requirements.
- Each exemption request will be considered on a case-by-case basis and you will be notified of the decision.
- Requests must be submitted annually.