Immunizations Forms | Notifications
2020-2021 NYSDOH Immunization Requirements for School Attendance Chart (7/20/20)
Sample Letter to Parents/Guardians for 2020-2021 immunizations for students
- Sample Immunization Request Letter to Parents of Students in PreK - 12 (7/2020)
- Chronological Age/Grade Chart (7/2/20)
Sample Letter for Administrators/Principals to Inform Parents/Guardians of Exclusion
Sample Exclusion Letter for Principal to Send to Parents - This sample letter for principals can be customized to send letters to parents/guardians whose children have not received the required immunizations for school attendance. The first page includes information for the administrator and should be deleted prior to sending it to parents and guardians. This resource includes a memo from the NYSDOH stating that immunizations are required whether learning is provided in-person, remotely or hybrid is also included. (NYSCSH, 9/19/20)
Sample Medical Exemption Letters/Forms From the NYSDOH and NYSCSH
- NYSDOH Notification to Providers Regarding Removal of Religious Exemptions and Medical Exemptions (NYSDOH, 7/2019)
- Guidance on Immunization-Related Medical Exemptions for School-Aged Children (NYSDOH, 6/2019)
- Immunization Requirements for School Attendance/Medical Exemption Statement for Children 0-18 years of Age Form. This form must be completed annually (NYSDOH).
- Medical Exemption Review Procedures for Schools Outside New York City and for Non-public Schools in NYC (NYSDOH, 6/2016).
- Sample Medical Exemption Approval Letter with Notification of Exclusion During Communicable Disease OutbreakThis sample letter may be customized to inform parents/guardians that their child has that in the case of an outbreak, their child would be excluded for the length of contagion. Ideally, this information should be communicated when the exemption is granted. (NYSCSH, 9/2019)
Page Updated 9/21/2020