Certificate of Immunization

The following form may be downloaded and filled out by your Doctor or Health Care Provider, indicating all immunizations you have received and on what date(s).

Exemption forms

Colorado law requires all students attending Colorado schools to be vaccinated against certain diseases unless they have a medical or non-medical exemption on file (Colorado Board of Health rule 6 CCR 1009-2). To protect unvaccinated students, individuals with an exemption from one or more required vaccines may be kept out of a school during a disease outbreak.

Non-medical exemptions

For non-medical exemptions from receiving MMR vaccines, the Non-Medical Exemption Form below must be signed by a medical provider, OR complete the online education module and submit the Certificate of Completion along with the Non-Medical Exemption Form.

Medical exemptions

For medical exemptions, the Medical Exemption Form below must be signed by a medical provider. Students who submit a completed medical exemption form need to file this form only once unless the student’s information or school changes.

Submitting your exemption form

Once you have completed either exemption form, print it out and submit via one of the following options:

Health information release forms

If you are requesting a copy of your immunization records please attempt to locate your original record before contacting us. If you are unable to obtain your original record you may request a copy from us by submitting the form below via email: hc_immun@fortlewis.edu or fax: 970-247-7621. Please allow 3-7 days to process your request. We will scan and email the record back to you and you will be responsible to forward this to the appropriate facility.

The below form is to request information to be sent from your physician to Fort Lewis College. Fill out this form and email it to hc_immun@fortlewis.edu or fax to 970-247-7621.