One Semester Waiver of Full-Time Restriction

I understand that my State of Tennessee Immunization Requirements are not complete. To qualify for this waiver you must be a new first time student who has received the first dose of Varicella (chicken pox) and the first dose of MMR (measles, mumps and rubella).
This immunization waiver is for select term Fall term Spring term Summer term Select year 2013 2014 2015 2016 2017 2018 2019 2020    

I will provide medical documentation of the second immunization(s) to Student/University Health Services (fax: 423-439-4560) prior to my NEXT SEMESTER REGISTRATION.

Failure to do this will prevent full-time enrollment. Full-time enrollment means 12 hours or more for undergraduate and 9 hours or more for graduate students.

Check immunization status in GoldLink to verify that proof has been received.

• Log into GoldLink using your username and password.
• Click the "My Student Info" tab.
• Under the "Registration Tools" box, choose Immunization Status.

If necessary requirements are not met, the one semester waiver will not be approved.

Student Name:
E#:
Email:
Telephone:	( ) -
Date:	6/20/2013 7:33:57 AM

I certify that the information is correct and my E Number acts as my electronic signature.

Questions regarding immunization requirements : contact Student Health Clinic (423) 439-4225.
Questions regarding completing this wavier: contact Registration Help Desk (423) 439-5584.