College Vaccine Exemptions

Simply put – it depends. Private religious schools are not beholden to the Americans with Disabilities Act (ADA) and may set their own policies. However, public schools and private schools receiving federal funding must accommodate a student whose disability makes vaccination more of a risk than a benefit. Under the ADA, a covered school or college must give disability accommodations to any qualified student, regardless of whether the student’s condition appears on the CDC’s official contraindication lists. The ADA’s definition of disability is very broad. In addition, federal laws like Section 504 of the Rehabilitation Act and the IDEA can apply to protect students with disabilities in schools. In short, if a student truly meets the ADA’s definition of disability with a valid medical reason, a school generally must consider the exemption—even if that condition is not listed by the CDC.

Medical vaccine exemptions are primarily governed by disability rights laws and state statutes. Federally, the ADA (and Section 504 for federally funded schools) applies to public colleges, as well as many private schools. These laws prohibit excluding a student because of a qualifying disability. In contrast, a purely private religious school or college is not bound by the ADA, but may be bound by Section 504, which prevents discrimination based on disability.

Some doctors are reluctant to write exemption letters either because they are unsure which conditions qualify legally or because of professional guidelines. If your provider refuses, you may want to seek legal help. Attorneys experienced in vaccine exemption law can often advise which medical conditions may qualify and work with your doctor to draft a letter that meets legal criteria. Essentially, the doctor must describe your diagnosis and explain medically why the vaccine poses a greater risk than benefit for you; an attorney can help ensure the wording is legally sound. Notably, Siri & Glimstad does not recommend physicians.

A covered institution cannot simply refuse to accept a properly submitted exemption request. If your school is subject to the ADA (or similar state disability law), it must at least process any reasonable request for  accommodation. Of course, the school can still deny the exemption if the documentation isn’t sufficient or if granting it truly imposes an undue hardship. In the vaccine context, schools often claim an undue hardship, stating that allowing an unvaccinated person would pose a health risk to others. Importantly, under the ADA “undue hardship” means significant difficulty or expense for the institution. Courts have held that, unless the school can prove a substantial risk or burden, merely allowing one more unvaccinated person is not automatically an undue hardship.

When a college or university cites “undue hardship” in the vaccine exemption context, it typically argues that having you unvaccinated would significantly increase the risk of disease spread on campus. In ADA terms, undue hardship means the proposed accommodation requires significant difficulty or expense. A school claiming undue hardship must show a real problem (for example, that the vaccine prevents transmission and your unvaccinated status would endanger others). If you can show that the vaccine does not reliably stop infection or spread (as with some vaccines), or that other measures (masks, distancing, testing) can mitigate risk, you may argue that the hardship claim is unfounded. (Notably, some legal analysts have pointed out that many vaccines mainly protect the recipient, so arguments about risk to others can be challenged).

• Medical diagnosis: The exemption must be based on a specific health condition, disability, or history thereof, explained by a qualified provider. Examples include severe allergies, prior serious reactions to a vaccine, chronic illnesses (diabetes, asthma, autoimmune disease, neurological disorders, etc.), mental health conditions, or other impairments.

• Provider’s documentation: A licensed healthcare professional (usually an MD, DO, NP, or PA)must write the exemption. (You may suggest language, but it needs the clinician’s signature). The letter should explicitly link your medical condition to vaccination and explain how, based on applicable guidance and current studies, the vaccine(s) poses more of a risk than a benefit to you.

• Appropriate language: The language  should follow CDC and ADA terminology as closely as possible. For instance, CDC defines a contraindication as a condition that significantly increases the risk of a serious vaccine reaction. The letter should explain why your condition makes the vaccine more of a risk than a benefit to you and meets the definition of a contraindication if possible.

• Specificity required: The exemption must be very specific. It should describe exactly how your condition limits a major life activity and why it prevents you from receiving the required vaccine(s). Vague claims or unsupported assertions will likely be rejected; typically you must show that based on the current applicable studies, these vaccines are more of a risk than a benefit to someone with your conditions.

• Professional help: Since many physicians are not familiar with the legal nuances of exemptions, it is often helpful to work with an attorney. A knowledgeable lawyer can help ensure the exemption letter uses the right terms and provides the necessary medical rationale.

For public institutions, yes – the Free Exercise Clause of the First Amendment prohibits them from discriminating against students with religious beliefs. The Supreme Court has made clear that if a policy has any secular exemption process (like a medical exemption), then denying a religious exemption creates a constitutional problem. In Fulton v. City of Philadelphia, the Court reiterated that where the government creates a system of individualized exemptions, it “may not refuse to extend that system to cases of ‘religious hardship’ without a compelling reason.”¹ In Tandon v. Newsom, the Court explained that a rule is not neutral/generally applicable whenever it treats “any comparable secular activity more favorably than religious exercise.”² However, states like Connecticut and Maine still maintain a “no-religious-exemptions” policy governed by state law, and neither state has been successfully challenged on the constitutionality of its statute. Additionally, private schools are not governed by the first amendment and may make their own policies regarding vaccine exemptions.

1  Fulton v. City of Philadelphia, 141 S. Ct. 1868, 1877 (2021) (quoting Emp. Div., Dep’t of Hum. Res. of Or. v. Smith, 494 U.S. 872, 884 (1990)).

2  Tandon v. Newsom, 141 S. Ct. 1294, 1296 (2021) (per curiam).

Not necessarily. Many private schools offer religious exemptions to their students; there are only a handful of private college and universities that will not accept a religious exemption. However, if the student is in a particular field that requires clinical rotations, the legal issues become far more complex. In a simple case of school attendance, while a private college has broad discretion, students may still explore various legal arguments when a school fails to provide a religious exemption option.Potential claims (depending on facts and state law) include: violating the school’s own nondiscrimination or anti-bullying policies, or conflicting with accreditation or state guidelines. Some students may also question the scientific basis for mandatory vaccines that don’t prevent transmission, arguing the mandate is unreasonable. It’s important to note that all of these arguments generally require first submitting a proper religious exemption request. If the student fails to present a valid exemption request, most of these claims have no legal footing.

• Violation of the college’s stated policies or mission (e.g. if it claims to respect religious freedom).

• Breach of accreditation standards or education laws (if relevant).

• Conflict with local or state health guidance.

• Argument that the mandate is scientifically unjustified (e.g. if the vaccine doesn’t block transmission, requiring it may be arbitrary).

Each of these theories turns on the specific facts and often assumes the student has already made a legally sufficient religious exemption request.

This largely depends on state law and the school’s own procedures.. Colleges and universities typically have their own form or policy for requesting religious accommodation. For public colleges and schools, any such policy must respect the First Amendment (as discussed above). Private colleges, by contrast, have more freedom to set their policies.

In general, a valid religious exemption request must articulate a sincerely held religious belief that prohibits the vaccine(s). Simply writing “My religion forbids vaccination” or “I am opposed to vaccines” is usually not enough. The student must explain how their religious faith or moral conscience specifically conflicts with the  required vaccines. Schools can and do probe the sincerity and religious nature of the beliefs. Note that “sincere” and “religious” are legal terms of art defined by case law – it’s not enough to feel strongly; the explanation must fit legal criteria. This is a legal accommodation process, not a theological debate. For example, the student should clearly connect their religious practice or belief to each vaccine. They should not include legal citations, health and safety arguments, political arguments, or any argument that falls outside of the scope of religion. If you are confused as to what information belongs in your statement and what does not, it is important to contact a qualified attorney. Siri & Glimstad has successfully helped hundreds of students navigate college exemption requests.  

Yes. In at least one case, a state court held that a private religious school was not required to honor a state-granted religious exemption for vaccinations. In Flynn v. Estevez (Fla. 2017), a Florida Catholic school refused to enroll a student who claimed a state-law religious exemption. The appeals court upheld the school’s right to enforce its own religious policy, invoking the church-autonomy doctrine. The court stated that constitutional protections do not allow the government to relabel a religious objection as secular in order to control a religious institution. In short, under Flynn, a private religious school could deny a religious exemption even though state law said public and other private schools must accept one. This same doctrine, the ecclesiastical abstention doctrine, applies to private religious colleges and universities as well.