Student/Trainee/Resident/Instructor COVID Exemption Drop Box

You will be asked to upload your Logan Health exemption form below.
Once submitted, we will process your exemption request. We will return your exemption form via email once it has been processed. You are responsible for providing an accurate email address.
Please DO NOT call or email to inquire about the status of your request.

1A. I am a(n) *
Student   Instructor   Trainee   Resident  

1B. School Attending or Residency Program *

1C. Program Name *

2. Today's Date: *

3. First and Last Name *

4. Phone Number *

5. Email Address *

6. Please upload Logan Health COVID-19 exemption form *

7. By typing my full name below I affirm that the information I am providing is accurate and up to date as of today's date. * *