CON Request for Waiver of Faculty Immunizations or CPR Requirements

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Appendices

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 (changes)
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.