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, and is confidential and only notification of approved accommodation will be shared with persons needing to know.