Please only complete this form if you are:

1. A student in a Faculty of Health Studies program (see list below)

2. You do not intend to receive 2 doses of COVID-19 vaccine

The purpose of this form is to let the Health Studies team know as soon as possible if you will not be receiving the COVID-19 vaccinations as we prepare to place students in practicums and placements in 2024-25. Please complete this form as soon as you can after beginning your program, and at least 90 days before your placement, to give the placement team as much time as possible to organize practicums and placements effectively.

Please be aware that many practicum and placement sites still require students to have two doses of COVID-19 vaccination. For this reason, we continue to highly recommend that all students in health programs with upcoming practicums or placements receive the vaccine to ensure students have maximum flexibility to be placed at our partner sites, and to avoid delays to program completion.

The personal information in this form is being collected under the authority of section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act. Your name and student ID will only be used to process your program practicum or placement. Please direct any questions about this form to: Sandrea Palmer, Divisional Coordinator, Faculty of Health and Community Studies, 10215-108 Street, Edmonton, AB T5J 1L6, Tel 780.644.6028, amy.stafford@norquest.ca.