This form is to be used for current & active university employees and VCU new hires.

VCU Health System employees do not need to fill out this form.

Dually employed employees must report vaccine documentation or submit an exemption request to both the University and VCU Health System

Please complete this form in its entirety. If you have filled out this form previously, and wish to fill it out again, it must be completed in its entirety.

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