Physical and Immunization Form:

All students must complete this form and submit it to Health Services. NO OTHER FORM WILL BE ACCEPTED. Minor students must have the form completed by a parent or guardian.

If attending in fall form is due July 15

If attending in spring form is due November 30

MLC Physical and Immunization Form

Immunization Exemption Form – Medical and Conscientious:

A student granted a medical or conscientious exemption from immunization requirements must present the college Health Service with a valid certificate of immunization exemption.  A medical exemption certificate is only valid when it documents a medical exemption and is signed by a licensed physician, nurse practitioner, or physical assistant. A certificate or notification for conscientious immunization exemption is only valid when notarized.

PLEASE NOTE that students who have filed an exemption certificate may be excluded from all campus activities, including classes, during a disease outbreak. The length of time a student is excluded from campus activities will vary depending on the type of disease and the circumstances surrounding the outbreak, and could range from several days to over a month.

Immunization Exemption Form MN DOH