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- UC San Diego Employees only. UCSD Students please follow exemption process outlined by Student Health.
- Please fill out all the following questions to start your COVID-19 Vaccine exemption/deferral request process.
Full Name (Last, First Middle)
Employee ID from UC Path (8 digits e.g. 10412345)
Type of Employee
UCSD Campus
UCSD Health/Health Sciences (School of Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences, Herbert Wertheim School of Public Health and Human Longevity Science)
Phone Number (xxx-xxx-xxxx)
Email
COVID-19 Vaccine Type of Exemption/Deferral Request
Medical
Disablity
Religious
Current Pregnancy
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