This form is meant for non-Atrium Health employees.

If you are an Atrium Health teammate, use the Vaccine Exemption/Other Form.

Students from non-Atrium Health schools should not use this form. We suggest that these students discuss with their schools whether they can accommodate their religious objection to the COVID-19 vaccine, or a rare medical need for exemption, by securing an alternative location for them to complete their clinicals.

Your Information

We understand and respect your decision. As part of the new exemption request process, you must first complete an education module. After completion of the module, you will be able to complete and submit your exemption request form with required attachments. Your request will be reviewed and you will receive a response via email.

To access the education module, please click the link associated with your market below. After course completion, note the verification code that must be entered below for exemption form submittal.

Carolinas College of Health Sciences
  • Please access the Vaccination: Covid-19 and Influenza Education Lesson in your New Student Onboarding course.
  • The specific link for the training will be found in the New Student Onboarding course once you are admitted to the college.
Greater Charlotte Region Education Module

Atrium Health Navicent
  • Navicent Education Module
  • Note: Your Student ID is the first 4 letters of your last name plus the last 4 digits of your social security number. Your Password is your entire first name (lower case)
  • Scroll to the bottom of your classroom and click Course Catalog (Register for a Course)
  • Scroll to the COVID 19 Response category and click Show All
  • Select Vaccination – COVID 19 and Influenza. Click the course title again in the display window. Click Register, return to your classroom and complete the course