Covid-19 Consent to Release Records

Covid-19 Consent to Release Records

Pursuant to the Texas Governor's Executive Order GA 35, Grayson College cannot require you to disclose whether or not you have received the Covid-19 vaccine to receive services from the college or to enter any college property.

However, the affiliate site where you will perform your clinical rotation requires that you disclose this information and attest to your vaccination status. Please be advised that should you elect not to obtain the vaccination and disclose this information, the affiliate site may not allow you to perform your clinical rotation at their facility based on their own internal policies and requirements.

Grayson College is only facilitating the disclosure of this information that is required by the affiliate site. Your voluntary disclosure of this information to the college is not a condition of receiving any service from Grayson College or entering into any college property.

If you qualify for an exemption from the affiliate site's vaccine requirement, please indicate that below and follow the guidelines provided by Grayson College.

First Name*

Last Name*

Student ID*

Viking Email*

Have you received the Covid-19 vaccine?*

Yes

Which vaccine did you receive?*

Pfizer

Moderna

Johnson & Johnson

Is your vaccine series complete?*

Yes

What was the date of your last shot?*

Are you exempt from this requirement?*

Yes

Have you filed an exemption through Grayson College?*

Yes

Exemption Form

Please click on the following link to fill out the Grayson College exemption form.

Exemption Form

You must submit this form along with your exemption form!

Send me a copy of my responses

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