Distance Only Attestation

Immunization Exemption Attestation

Name:

Stony Brook ID#
Please enter this number carefully

Email Address:

Local telephone#

Select the option below that supports your exemption for campus immunization requirements:

I am enrolled exclusively in fully online classes
I am enrolled exclusively in study abroad courses

Select the College or School with which you have a primary affiliation:

Please carefully read the attestation below and select the box below to confirm that you will not physically be on Stony Brook’s campus:

I confirm that for the semester(s) selected below, I am enrolled EXCLUSIVELY in fully online classes or studying abroad and will NOT be physically present on campus including, but not limited to, visiting in-person office hours; working on campus; participating in in-person student clubs, organizations, and events; or utilizing in-person student services such as the library, gym, and tutoring.

If it is discovered that I was physically present on campus during the periods I have selected below, and I am unvaccinated, then I understand that I will be referred to the Office of Student Conduct and Community Standards for violating the Code of Student Responsibility. I acknowledge that if in the upcoming or another semester I decide to enroll in at least one in-person class, live on campus, work on campus, or access in-person services or facilities, then I will submit my required immunization records.

Please select the semester(s) that corresponds to the semester(s) in which you will be either enrolled EXCLUSIVELY in fully online classes or studying abroad and will NOT be physically present on campus.

Summer 2023 Semester

Fall 2023 Semester

Additional comments or clarifications:

Note, a copy of your attestation will be sent to the email address you specify above. Upon our team’s review of this attestation, your SOLAR registration hold will be removed within two business days and you will not be required to obtain or submit proof of your immunizations for the upcoming semester.