How to Request an Exemption

You may request an exemption from the COVID-19 vaccination requirement on the basis of verified medical reasons or sincerely held religious beliefs. There is a separate form and process for each type of request. You will receive a response as soon as possible.



Requesting a Medical Exemption

Download the Medical Exemption Request Form

  1. Download the form
  2. Complete the first section of the form on your computer, print it out and sign it.
  3. Ask your medical provider to complete and sign the second section.
  4. Scan the completed form to create a PDF.
  5. Upload this form through the PyraMED health portal. Here's how:

Have your completed form ready

  • You can scan or take a photo of your exemption request form.
  • Save the digital photo or file to the computer or device that you will use to log in to the PyraMED health portal.

Log in to the PyraMED health portal

  • PyraMED Health Services tileOpen the Apps section of MyPortal and click on the tile for PyraMED Health Services.
  • As an alternative, you can go to deanza.studenthealthportal.com
  • If you are prompted to sign in, use your eight-digit CWID (your student ID number, also known as a Campuswide ID) and MyPortal password.

(Students must be registered in at least one class to access the PyraMED portal.)

Sign the "Consent for Treatment"

If you haven't already signed the Informed Consent for Treatment form, you'll need to do this before uploading your vaccination record. When the PyraMED home screen appears

  • Click on My Forms (in the red horizontal bar across the top of your screen). 

PyraMED home screen

  • Next, look under Pending Forms and select the Informed Consent for Treatment form.

PyraMED My Forms screen

  • Open this form, read it and follow the instructions to sign it online.
  • Remember to click the Submit button when you are finished.

Follow the on-screen instructions to upload your request

After you've signed the Consent for Treatment form, you can upload the exemption request form. (Keep the PyraMED screen open to do this.) 

  • Click on Document Upload (in the red horizontal bar across the top of your screen). This should open a screen like the one shown here.

screenshot of PyraMED upload screen

  • Next, select COVID-19 Request Medical Exemption Form – De Anza as the document type.

screenshot of PyraMED upload screen with exemption request as document type

  • Click the Browse button to find the document file on your computer or device.
    (Your document file must be in one of the formats listed, such as .jpeg or .pdf)
  • Click the Save button to upload the document.
  • You will not receive an immediate confirmation. The Health Services office will contact you if they have any questions.

Remember these important points

  • You may not come to campus until your request has been approved.
  • We strongly recommend that you submit your request at least three days before your first visit to campus.


Requesting a Religious Exemption

Please visit the Religious Exemption Request webpage to complete the online form. 

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