Request for Facial Covering Exemption

This form is used to initiate a request for an exemption from wearing a facial covering in the college due to a health condition. Once submitted, you may be contacted for additional information. Please note that an exemption based on the submission of this form is considered temporary in the case that the request requires medical documentation to support a permanent exemption. Medical information obtained during this process will require your consent in accordance with the Health Insurance and Portability and Accountability Act of 1996 (HIPPA https://www.hhs.gov/hipaa/index.html), and is confidential and only notification of approved accommodation will be shared with persons needing to know.

Understanding the Risks and Assuming Responsibility

I understand the risks of being in the community and on campus and understand that I may be exposed to COVID-19. I will take responsibility for my own health and help prevent the spread of COVID-19 on campus and in the community.

I know that by engaging in campus activities and attending classes I may be exposed to COVID-19 and other infections. I also understand that despite the efforts of Southern State Community College to reduce the risks of COVID-19, I can still contract COVID-19 and/or other infections that can cause serious illness and even death. Click here for Centers for Disease Control (CDC) recommendations which include wearing a mask as a preventative measure for the transmission of COVID19. As I attest that I require a mask exception, I take the responsibility of this risk and will engage in disease transmission prevention guidelines, including: conducting daily symptom monitoring, not coming to campus if sick, distancing, hand sanitizing, and the option to vaccinate. In case of exposure or illness I agree to participate in testing, contact tracing, quarantine and isolation procedures, outlined in the transitional recovery plan. Click here for the summary. I will stay informed of SSCC COVID-19 related communications, as the college may modify guidelines and expectations as new information becomes available.