CON Request for Waiver of Faculty Immunizations or CPR Requirements

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UNIVERSITY OF NEBRASKA MEDICAL CENTER
COLLEGE OF NURSING
Request for Waiver of Faculty Immunizations or CPR Requirements Subsection: Appendix M
Section - Appendices Originating Date: October 2003
Responsible Reviewing Agency:
Executive Council
Faculty Coordinating Council
Revised: February 2008
Reviewed: May 2016
Revised: March 2018
Related documents:
4.2.12


I, ________________________________________________, request a waiver of requirements for the following immunization(s) and/or CPR (please list):

for the following reason(s) (ex. allergy):

_______________________________________________   _______________________________
Faculty Signature   Date
 
Submit completed/signed form to conrecords@unmc.edu
 
Note: For recurring requirements, form should be submitted each time requirements comes due.