I affirm that the above information I have provided is complete and accurate. I understand that, if granted an exemption, I must comply with all mitigation measures required of me by the University. Such measures include but are not limited to: participating in COVID-testing at a frequency determined by the University, wearing face covering in settings determined by the University (classrooms, labs, etc.) and maintaining certain physical distancing as determined by the University and applicable public health orders. I understand that I am placing myself at an increased risk of contracting COVID-19, a serious disease, should I continue to come into contact with others without being able to vaccinate. I understand that my request for an exemption may not be granted or may be rescinded if it creates an undue hardship for the University. I understand that any intentional misrepresentation contained in this request may result in disciplinary action up to and including dismissal from the University.