State School Immunization Requirements and Vaccine Exemption Laws

State School Immunization Requirements and

Vaccine Exemption Laws

State laws establish vaccination requirements for school children. These vaccination laws often apply not only to

children attending public schools, but also to those attending private, parochial, and other types of schools.

1

State

laws also offer exemptions to school vaccination requirements, including medical, religious, and philosophical

exemptions or some combination of these exemptions.

2

Th

e Centers for Disease Control and Prevention’s (CDC’s) Public Health Law Program (PHLP), within the Center for

State, Tribal, Local, and Territorial Support, has conducted an assessment of state statutes, regulations, and state

health department policies (collectively referred to as “laws”) regarding school vaccinations. This document is a

2019 update

3

of state vaccination laws originally collected in 2015 and updated previously in 2017. This 2019

assessment addresses vaccinations required for grades K-12; it does not include vaccinations required for

preschool children only or for higher education. Each section of the menu below provides examples of state laws

on school vaccination requirements or examples of laws about exemptions from those requirements. The

appendices provide data on laws from all fifty states collected in the 2019 assessment.

Fo

r questions related to this document or to request updates to relevant immunization laws for your state, please

email PHLP at PHLawProgram@cdc.gov

. Note that the information contained in this document was collected for

research and educational purposes. Please contact your local or state health department for school vaccination

requirements that may apply to your individual circumstances.

State Vaccination Requirements in K-12 Schools

All states require children to be vaccinated against certain communicable diseases as a condition for

school attendance.

4

Most state school vaccination laws expressly apply to both public and private

schools.

5

Homeschools are expressly covered by school vaccination requirements in several states.

6

1

See, e.g., Colo. Rev. Stat. § 25-4-901; Haw. Rev. Stat. § 302A-901; N.Y. Public Health Law § 2164; N.D. Cent. Code

§ 23-07-17.1; Tenn. Comp. R. & Regs. 1200-14-01-.29; Wash. Rev. Code Ann. § 28A.210.080.

2

See, e.g., Ala. Code § 16-30-3; Cal. Health & Safety Code § 120370; Haw. Rev. Stat. § 302A-1156; Neb. Rev. Stat. §

79-221; Ohio Rev. Code Ann. § 3313.671(B)(4), (5); W. Va. Code § 16-3-4.

3

PHLP collected statutes and regulations using a search in the legal database Westlaw on July 8-9, 2019. Policy

documents for the 2019–2020 school year were collected from state websites between January and March 2020.

4

See, e.g., Fla. Stat. § 1003.22; Nev. Rev. Stat. § 394.192; Va. Code. Ann. § 32.1-46.

5

See, e.g., Ala. Code § 160-30-4; Mich. Comp. Laws § 380.1177; N.C. Gen. Stat. § 130A-155.

6

See, e.g., Minn. Stat. § 121A.15; Tenn. Code Ann. § 49-6-3050; Va. Code Ann. § 22.1-271.4. Additional jurisdictions

may have vaccination requirements for homeschools; PHLP did not conduct a 50-state assessment on coverage of

homeschools by state school vaccination laws.

February

2022

2

Required Vaccines for Entry into Kindergarten and Later Grades

Four common childhood vaccines—DTaP, MMR, polio, and varicella—are required for children to enroll

in kindergarten in almost every state.

7

Many states require the meningococcal (meningitis) vaccine for

entry into later grades, often at 7th grade.

8

Some states require additional vaccines, either for entry into

kindergarten or for entry into later grades.

 Alaska is one of several states that require hepatitis A and hepatitis B vaccines for entry into

kindergarten: “Before entry in a state public school district or nonpublic school offering pre-

elementary education through the 12th grade, or any combination of these grades, a child shall

be immunized against (1) diphtheria, tetanus, polio, pertussis, measles, mumps, hepatitis A,

hepatitis B, and rubella, except rubella is not required in children 12 years of age or older; and

(2) beginning July 1, 2009, varicella.”

9

 For entry into later grades, Rhode Island requires the human papillomavirus (HPV) vaccine,

according to the following schedule: “Beginning August 1, 2015, all students entering seventh

(7th) grade shall be required to have at least one (1) dose of the HPV vaccine series. Beginning

August 1, 2016, all students entering eighth (8th) grade shall be required to have at least two

(2) doses of the HPV vaccine series. Beginning August 1, 2017, all students entering ninth (9th)

grade shall be required to have completed the HPV vaccine series (3 doses).”

10

Acceptable Proof of Immunization

State laws vary on the types of acceptable proof of immunization for enrollment in grades K-12. Among the

different types of acceptable documentation are medical records, a health department or school form, information

from the state’s Immunization Information System (IIS), or a “certificate of immunization,” which may be issued by,

for example, a state health department or a physician’s office.

11

In a few states, a parental report is allowed.

12

 Kentucky requires a “current Commonwealth of Kentucky Certificate of Immunization,” which “shall be

issued by: (a) A physician licensed in any state; (b) An advanced practice registered nurse licensed in any

state; (c) A physician assistant licensed in Kentucky; (d) A pharmacist licensed in Kentucky; (e) A local health

department in Kentucky; (f) A licensed healthcare facility administering immunizations in Kentucky; or (g) An

authorized user of the Kentucky Immunization Registry.”

13

 Minnesota allows for substitution of a parental report in place of other records: “A person who is enrolling

or enrolled in an elementary or secondary school . . . may substitute a statement from . . . a parent or

guardian if the person is a minor child in lieu of the statement from a physician or public clinic which

provides immunizations. If the statement is from a parent or guardian or emancipated person, the

statement must indicate the month and year of each immunization given.

14

7

See, e.g., Ark. Code R. § 005.15.23-3.0; 6 Colo. Code. Regs §1009-2; Ga. Comp. R. & Regs. 511-2-2-.02; Md. Code

Regs. 10.06.04.03. DTaP protects against diphtheria, tetanus, and pertussis (whooping cough); MMR protects

against measles, mumps, and rubella. The only state that does not require all the listed vaccines is Iowa, which

does not require a mumps vaccine. Iowa Code § 139A.8.

8

E.g., Del. Admin. Code § 804; 05-071-26 Me. Code R. § 5; 216 R.I. Code R. § 30-0503.5.

9

Alaska Admin. Code tit 4, § 06.055(a)(1).

10

216 R.I. Code R. § 30-05-3.5.

11

See, e.g., Alaska Admin. Code tit. 4, § 06.055; Ark. Admin. Code § 005.15.23-4.0; 902 Ky. Admin. Regs 2:060; S.C.

Code Ann. Regs. R. 61-8; Vt. Admin. Code § 12-5-5:9.0.

12

See, e.g., Minn. Stat. § 121A.15(Subd.4); Or. Rev. Stat. § 433.267(1)(a).

13

902 Ky. Admin. Regs 2:060.

14

Minn. Stat. § 121A.15(Subd.4).

3

See APPENDIX A, Tables A1 and A2, for state data on vaccine requirements and acceptable proof of

vaccination.

State Laws Regarding School Vaccination Exemptions

State laws also establish exemptions for school vaccination requirements, including requirements

regarding the exemption application process. The graph below and this document explore several

attributes of state laws on school vaccination exemptions. These include whether a state:

1. Permits medical exemptions only

2. Permits medical and religious exemptions

3. Permits medical, religious, and philosophical exemptions

4. Requires parental acknowledgment during the exemption application process that exempted

students can be excluded from school during outbreaks

5. Establishes that exemptions might not be recognized in the event of an outbreak

6. Requires notarization of documents in the exemption application process

7. Requires parental education on vaccinations in the exemption application process

8. Addresses the duration of medical exemptions (e.g., temporary or permanent)

Types of School Vaccination Exemptions

There are three principal types of exemptions from school vaccination requirements: medical, religious,

and philosophical

15

exemptions. All states offer medical exemptions but there is variation among the

15

Philosophical exemptions are based on personal or moral grounds, rather than strictly religious beliefs.

4

states on the types of non-medical exemptions offered. In addition, most states allow students to be

exempt from only certain vaccination requirements; often the state will require the physician or parent

to specify which vaccines are to be considered in the exemption process.

16

On occasion, a state will

prohibit non-medical exemptions from specific vaccines.

17

 California allows only medical exemptions: “If the parent or guardian files with the governing

authority a written statement by a licensed physician to the effect that the physical condition of

the child is such, or medical circumstances relating to the child are such, that immunization is

not considered safe, indicating the specific nature and probable duration of the medical

condition or circumstances, including, but not limited to, family medical history, for which the

physician does not recommend immunization, that child shall be exempt from the requirements

of Chapter 1 . . . to the extent indicated by the physician’s statement.”

18

 North Dakota, which allows medical and religious exemptions, requires the physician or parent

to specify the vaccines: “A child with a medical or a beliefs exemption is exempt from any one or

all of the immunization requirements. A physician must sign an exemption form indicating the

vaccines that are included in the medical exemption. A parent or guardian must sign an

exemption form stating that the child has a beliefs exemption and indicate which vaccines are

exempt because of beliefs.”

19

 Washington state allows medical, religious, and philosophical exemptions, but it does not allow

philosophical exemptions for the MMR vaccine. A child will be exempt from the state’s school

vaccination requirements for philosophical reasons “upon the presentation of . . . [a] written

certification signed by any parent or legal guardian of the child or any adult in loco parentis to

the child that the signator has either a philosophical or personal objection to the immunization

of the child. A philosophical or personal objection may not be used to exempt a child from the

measles, mumps, and rubella vaccine.”

20

Parental Acknowledgement of Exclusion from School During an Outbreak

State laws often require parental acknowledgment during the exemption application process that

exempted students can be excluded from school during an outbreak or epidemic.

21

 Under Arkansas law, exemption applications require parents to sign a statement of

understanding that “[a]t the discretion of the Department of Health, the unimmunized child or

individual may be removed from day care or school during an outbreak if the child or individual

is not fully vaccinated.”

22

 Under Georgia law, a parent seeking a religious exemption must sign an affidavit stating, “I

understand that, notwithstanding my religious objections, my child may be excluded from

childcare facilities or schools during an epidemic or threatened epidemic of any disease

preventable by a vaccination required by the Georgia Department of Public Health, and that my

16

See, e.g., Mich. Admin. Code r. 325.176; Minn. Stat. Ann. § 121A.15(3); N.D. Admin. Code 33-06-05-01(4); S.C.

Code Ann. Regs. 61-8(11)(A); Utah Code Ann. 1953 § 53G-9-304.

17

E.g., Wash. Rev. Code § 28A.210.090.

18

Cal. Health & Safety Code § 120370.

19

N.D. Admin. Code 33-06-05-01(4).

20

Wash. Rev. Code § 28A.210.090.

21

See, e.g., Ark. Code Ann. § 6-18-702(d)(4)(C)(iv); Ga. Comp. R. & Regs. 511-2-2-.07; Ill. Admin. Code tit. 77, § 665.510.

22

Ark. Code Ann. § 6-18-702(d)(4)(C)(iv).

5

child may be required to receive a vaccination in the event that such a disease is in epidemic

stages.”

23

 In Illinois, parents seeking a religious exemption must sign a Certificate of Religious Exemption

describing the objection, which “shall also reflect the parent’s or legal guardian’s understanding

of the school’s exclusion policies in the case of a vaccine-preventable disease outbreak or

exposure.”

24

Exemptions Might Not Be Recognized During an Outbreak

In some cases, state law establishes that exemptions might not be recognized during an outbreak,

epidemic, or emergency.

25

 Under Hawaii law, “[i]f at any time there is, in the opinion of the department of health, danger

of an epidemic from any of the communicable diseases for which immunization is required

under sections 302A-1154 to 302A-1163, no exemption from immunization against the disease

shall be recognized.”

26

 Kentucky law allows for medical and religious exemptions “[p]rovided, however, that in the

event of an epidemic in a given area, the Cabinet for Health and Family Services may, by

emergency regulation, require the immunization of all persons within the area of epidemic,

against the disease responsible for such epidemic.”

27

 Under North Dakota law, “[w]hen, in the opinion of the health officer, danger of an epidemic

exists from any of the communicable diseases for which immunization is required under this

section, the exemptions from immunization against such disease may not be recognized and

children not immunized must be excluded from an institution listed in subsection 1 until, in the

opinion of the health officer, the danger of the epidemic is over.”

28

Requirement for Notarization in Exemption Application

Some states require notarization of the forms or other statements associated with the exemption

application, most often with non-medical exemptions.

29

 Arkansas requires a “notarized statement requesting a religious, philosophical, or medical

exemption from the Department of Health by the parents or legal guardian of the child.”

30

 Minnesota law allows for philosophical exemptions with “a notarized statement signed by the

minor child's parent or guardian . . . stating that the person has not been immunized . . . because

of the conscientiously held beliefs of the parent or guardian of the minor child."

31

 Virginia law states that “[n]o certificate of immunization shall be required for the admission to

school of any student if [t]he student or his parent or guardian submits a notarized Certificate of

23

Ga. Comp. R. & Regs. 511-2-2-.07.

24

Ill. Admin. Code tit. 77, § 665.510.

25

See, e.g., Haw. Rev. Stat. § 302A-1157; Ky. Rev. Stat. § 214.036; N.D. Cent. Code § 23-07-17.1(6).

26

Haw. Rev. Stat. § 302A-1157.

27

Ky. Rev. Stat. § 214.036.

28

N. D. Cent. Code § 23-07-17.1(6).

29

See, e.g., Ark. Code Ann. § 6-18-702(d)(1)(4)(C); Minn. Stat. Ann. § 121A.15(3)(d); Va. Admin. Code § 5-110-80(A)(1).

30

Ark. Code Ann. § 6-18-702(d)(1)(4)(C); Ark. Admin. Code § 005.15.23-5.0(5.01.1).

31

Minn. Stat. Ann. § 121A.15(3)(d).

6

Religious Exemption . . . stating that the administration of immunizing agents conflicts with the

student's religious tenets or practices.”

32

Requirement That Exemption Application Process Include Parental Education

Several states require that their exemption process include an educational component that discusses the

benefits of vaccination and the risks of not being vaccinated. This requirement is more frequently

associated with religious and philosophical exemptions.

33

 Arizona’s philosophical exemption application requires “a signed statement to the school

administrator stating that the parent or guardian has received information about immunizations

provided by the department of health services and understands the risks and benefits of

immunizations and the potential risks of nonimmunization.”

34

 Vermont’s religious exemption application requires that an applicant “has reviewed evidence-

based educational material provided by the Department regarding immunizations, including: (i)

information about the risks of adverse reactions to immunization; (ii) information that failure to

complete the required vaccination schedule increases risk to the person and others of

contracting or carrying a vaccine-preventable infectious disease; and (iii) information that there

are persons with special health needs attending schools and child care facilities who are unable

to be vaccinated or who are at heightened risk of contracting a vaccine-preventable

communicable disease and for whom such a disease could be life-threatening.”

35

 Oregon’s process for religious and philosophical exemptions must include either “(i) A signature

from a health care practitioner verifying that the health care practitioner has reviewed with the

parent information about the risks and benefits of immunization . . . or (ii) A certificate verifying

that the parent has completed a vaccine educational module.”

36

Duration of Exemptions

Many states expressly address the duration of an exemption, most often in relation to medical

exemptions. This includes, for example, whether an exemption is temporary, permanent, or, for medical

exemptions, within the physician’s discretion.

37

 In Georgia, “[a] Certificate of Immunization indicating medical exemption shall be valid for one

year, and may be reissued from year to year until the physician determines that immunization

or a specific immunization may finally be accomplished without danger to the child's health.”

38

 In New Mexico, medical and religious exemptions “are valid for a period not to exceed nine (9)

months and will not extend beyond the end of the school year in which the child is currently

enrolled.”

39

 West Virginia law states that “[i]f a child has been granted an exemption from receiving one or

more vaccinations, the certificate of immunization must indicate the vaccine(s) for which the

32

Va. Admin. Code § 5-110-80(A)(1).

33

See, e.g., Ariz. Rev. Stat. Ann. § 15-873; Or. Rev. Stat. § 433.267(1)(c); Or. Admin. R. 333-050-0040(1)(d); Utah Code Ann. 1953

§ 53G-9-304; Vt. Stat. Ann. 18 § 1122(a)(3); Wash. Rev. Code § 28A.210.090(2)(a).

34

Ariz. Rev. Stat. Ann. § 15-873.

35

Vt. Stat. Ann. 18 § 1122(a)(3).

36

Or. Rev. Stat. § 433.267(1)(c); Or. Admin. R. 333-050-0040(1)(d).

37

See, e.g., Conn. Agencies Regs. § 10-204a-3a; Ga Comp. R. & Regs. 511-2-2-.05; Kan. Stat. Ann. § 72-6262(b)(1); Mont. Admin.

R. 37.114.715; N.M. Stat. Ann. § 24-5-3(B); W. Va. Code R. § 64-95-14.

38

Ga Comp. R. & Regs. 511-2-2-.05.

39

N.M. Stat. Ann. § 24-5-3(B).

7

child is exempted, the reason for the exemption, and whether or not the reason for the

exemption is permanent or temporary.”

40

See APPENDIX B, Tables B1 and B2, for state data on exemptions. State data on additional variables

examined in the 2019 assessment but not discussed above can be found in APPENDIX C.

41

Citations to

state statutes and regulations relied on for Tables A, B, and C are presented in APPENDIX D.

Acknowledgments and Disclaimers

Those who developed and contributed to this 2019 assessment of school vaccination laws include

Russell McCord, JD; Mara Howard Williams, JD, MPH; Lisa Landsman, JD, MPH; Jada Fehn, JD, DRT

Strategies; and Dana Lohrberg, JD, DRT Strategies—with the assistance of Matthew Penn, JD, MLIS,

Director, Public Health Law Program (PHLP), within the Centers for Disease Control and Prevention’s

Center for State, Tribal, Local, and Territorial Support.

The original 2015 menu and 2017 update of school vaccination laws were developed by Aila Hoss, JD,

Carter Consulting, Inc.; Alexandra Bhatti, JD, MPH, Chenega Professional and Technical Services LLC;

Cason Schmit, JD, Texas A&M University School of Public Health; and Matthew Penn, JD, MLIS, Director,

Public Health Law Program. This project was originally developed in collaboration with staff from the

National Center for Immunization and Respiratory Diseases.

PHLP provides technical assistance and public health law resources to advance the use of law as a public

health tool. PHLP cannot provide legal advice on any issue and cannot represent any individual or entity

in any matter. PHLP recommends seeking the advice of an attorney or other qualified professional with

questions regarding the application of law to a specific circumstance. The findings and conclusions in this

summary are those of the authors and do not necessarily represent the official views of CDC.

40

W. Va. Code R. § 64-95-14(14.2).

41

The 2019 update asked some additional questions about state school immunization requirements not

summarized in this document. Among these are: (1) Is a specific form required for an exemption; (2) Is a

parental signature required for an exemption; (3) Does the exemption require a medical practitioner’s

signature; (4) Does the exemption require additional documentation other than a standard form or

statement from a parent; (5) Does the exemption require governmental approval to be valid; and (6) For

medical exemptions only, does the state require a provider to specify a condition or other medical

reason that prevents the student from being vaccinated.

8

Appendix A: Table A1 Vaccines Required for Entry into Kindergarten and Later Grades (K-12) (2019)

State

Which of the following vaccines are required for children to enroll in

kindergarten?

Which of the following vaccines are

required for the first time for children to

enter grades other than kindergarten?

DTaP

(Diphtheria,

Tetanus,

Pertussis)

MMR

(Measles,

Mumps,

Rubella)

Polio

Varicella

Hep A

Hep B

Other

Meningitis

HPV

Other

Alabama

X

Alaska

X

Arizona

X

Arkansas

X

California

X

Colorado

X

Connecticut

X

Delaware

X

Florida

X

Georgia

X

Hawaii

X

Idaho

X

Illinois

X

i

Indiana

X

Iowa

X

ii

X

Kansas

X

Kentucky

X

Louisiana

X

Maine

X

Maryland

X

Massachusetts

X

Michigan

X

Minnesota

X

Mississippi

X

Missouri

X

Montana

X

Nebraska

X

Nevada

X

New Hampshire

X

New Jersey

X

New Mexico

X

New York

X

North Carolina

X

iii

X

North Dakota

X

Ohio

X

Oklahoma

X

Oregon

X

Pennsylvania

X

Rhode Island

X

South Carolina

X

South Dakota

X

Tennessee

X

Texas

X

Utah

X

Vermont

X

Virginia

X

Washington

X

West Virginia

X

Wisconsin

X

Wyoming

X

Legend: “X” = yes; blank = no or not specified

9

Appendix A: Table A2 Acceptable Proof of Vaccination (2019)

State

Which of the following are accepted by the state as proof of immunization?

Immunization

Information

System (IIS)

Provider medical

records or

printout

Health

department or

school form or

record

Parental

report

Certificate of

Immunization

Other

Not

specified

Alabama

X

Alaska

X

Arizona

X

Arkansas

X

California

X

Colorado

X

Connecticut

X

Delaware

X

Florida

X

Georgia

X

Hawaii

X

Idaho

X

Illinois

X

Indiana

X

Iowa

X

Kansas

X

Kentucky

X

Louisiana

X

Maine

X

Maryland

X

Massachusetts

X

Michigan

X

Minnesota

X

Mississippi

X

Missouri

X

Montana

X

Nebraska

X

iv

Nevada

X

New Hampshire

X

v

New Jersey

X

New Mexico

X

New York

X

North Carolina

X

North Dakota

X

vi

Ohio

X

Oklahoma

X

Oregon

X

Pennsylvania

X

Rhode Island

X

South Carolina

X

South Dakota

X

Tennessee

X

Texas

X

vii

Utah

X

Vermont

X

Virginia

X

Washington

X

West Virginia

X

Wisconsin

X

Wyoming

X

Legend: “X” = yes; blank = no or not specified

10

Appendix B: Table B1 State Vaccination Exemption Laws (2019)

State

Which types of exemptions are permitted

in this state?

Does the state allow students to be

exempt from only certain

vaccination requirements?

Do any exemptions require a parent to

acknowledge that their child may be

excluded from school in the event of

an outbreak?

Medical

Religious

Philosophical

Medical

Non-medical

Medical

Non-medical

Alabama

X

Alaska

X

Arizona

X

Arkansas

X

California

X

n/a

Colorado

X

Connecticut

viii

X

Delaware

X

Florida

X

Georgia

X

Hawaii

X

Idaho

X

Illinois

X

Indiana

X

Iowa

X

Kansas

X

Kentucky

X

Louisiana

X

Maine

ix

X

Maryland

X

Massachusetts

X

Michigan

X

Minnesota

X

Mississippi

X

n/a

Missouri

X

Montana

X

Nebraska

X

Nevada

X

New Hampshire

X

New Jersey

X

New Mexico

X

New York

X

n/a

North Carolina

X

North Dakota

X

Ohio

X

Oklahoma

X

Oregon

X

Pennsylvania

X

Rhode Island

X

South Carolina

X

South Dakota

X

Tennessee

X

Texas

X

Utah

X

Vermont

X

Virginia

X

Washington

X

x

X

West Virginia

X

n/a

Wisconsin

X

Wyoming

X

Legend: “X” = yes; blank = no or not specified; “n/a” indicates the state has no non-medical exemptions

11

Appendix B: Table B2 State Vaccination Exemption Laws (2019)

State

Does the state disallow any

exemptions in the event of an

emergency, epidemic, or

outbreak?

Does the state require

exemption documentation to be

notarized?

Does the state require parental

education prior to granting the

exemption?

Does the state expressly

address the duration of an

exemption?

Medical

Non-medical

Medical

Non-medical

Medical

Non-medical

Medical

Non-medical

Alabama

X

Alaska

X

Arizona

X

Arkansas

X

California

n/a

X

n/a

Colorado

X

Connecticut

X

Delaware

X

Florida

X

Georgia

X

Hawaii

X

Idaho

X

Illinois

X

Indiana

X

Iowa

X

Kansas

X

Kentucky

X

Louisiana

Maine

X

Maryland

X

Massachusetts

X

Michigan

X

Minnesota

X

Mississippi

n/a

X

n/a

Missouri

X

Montana

X

Nebraska

X

Nevada

X

New Hampshire

X

New Jersey

X

New Mexico

X

New York

n/a

X

n/a

North Carolina

X

North Dakota

X

Ohio

Oklahoma

Oregon

X

Pennsylvania

X

Rhode Island

X

South Carolina

X

South Dakota

Tennessee

X

Texas

X

Utah

X

Vermont

X

Virginia

X

Washington

X

West Virginia

n/a

X

n/a

Wisconsin

Wyoming

Legend: “X” = yes; blank = no or not specified; “n/a” indicates the state has no non-medical exemptions

12

Appendix C: Table C1 Additional Variables - State Vaccination Exemption Laws (2019)

State

Is a specific form required for an

exemption?

Is a parental signature required

for an exemption?

Does the exemption require a

medical practitioner’s

signature?

Medical

Non-medical

Medical

Non-medical

Medical

Non-medical

Alabama

X

Alaska

X

Arizona

X

Arkansas

X

California

n/a

X

n/a

Colorado

X

Connecticut

X

Delaware

X

Florida

X

Georgia

X

Hawaii

X

Idaho

X

Illinois

X

Indiana

X

Iowa

X

Kansas

X

Kentucky

X

Louisiana

X

Maine

Maryland

X

Massachusetts

Michigan

X

Minnesota

X

Mississippi

X

n/a

X

n/a

Missouri

X

Montana

X

Nebraska

X

Nevada

X

New Hampshire

X

New Jersey

X

New Mexico

X

New York

X

n/a

X

n/a

North Carolina

X

North Dakota

X

Ohio

X

Oklahoma

X

Oregon

X

Pennsylvania

X

Rhode Island

X

South Carolina

X

South Dakota

X

Tennessee

X

Texas

X

Utah

X

Vermont

X

Virginia

X

Washington

X

West Virginia

X

n/a

X

n/a

X

n/a

Wisconsin

X

Wyoming

X

Legend: “X” = yes; blank = no or not specified; “n/a” indicates the state has no non-medical exemptions

13

Appendix C: Table C2 Additional Variables - State Vaccination Exemption Laws (2019)

State

Does the exemption require

additional documentation

other than a standard form or

statement?

Does the exemption require

governmental approval to be

valid?

For medical exemptions only, does

the state require a provider to

specify a condition or other

medical reason that prevents the

student from being vaccinated?

Medical

Non-medical

Medical

Non-medical

Alabama

Alaska

Arizona

X

Arkansas

X

California

X

n/a

X

Colorado

X

Connecticut

X

Delaware

X

Florida

X

Georgia

Hawaii

X

Idaho

Illinois

X

Indiana

X

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

X

Massachusetts

X

Michigan

X

Minnesota

Mississippi

n/a

X

n/a

X

Missouri

X

Montana

X

Nebraska

Nevada

New Hampshire

New Jersey

X

New Mexico

X

New York

n/a

X

n/a

X

North Carolina

X

xi

X

North Dakota

Ohio

X

Oklahoma

X

Oregon

X

Pennsylvania

Rhode Island

X

South Carolina

South Dakota

Tennessee

Texas

X

Utah

X

Vermont

X

Virginia

X

Washington

X

West Virginia

X

n/a

X

n/a

X

Wisconsin

Wyoming

X

Legend: “X” = yes; blank = no or not specified; “n/a” indicates the state has no non-medical exemptions

14

Appendix D: Citations – Statutes and Regulations

References for Table Data: Statutes and Regulations by State

xii

State

Statutes and Regulations

Alabama

Ala. Code § 16-30-3; Ala. Code § 16-30-4; Ala. Admin. Code r. 420-6-1-.02; Ala. Admin.

Code r. 420-6-1-.03

Alaska

Alaska Admin. Code tit. 4, § 06.055

Arizona

Ariz. Rev. Stat. Ann. § 15-873; Ariz. Admin. Code § 9-6-702; Ariz. Admin. Code § 9-6-

704; Ariz. Admin. Code § 9-6-706

Arkansas

Ark. Code Ann. § 6-18-702; Ark. Admin. Code 005.15.1-II; Ark. Admin. Code 005.15.1-

III; Ark. Admin. Code 005.15.23-3.0; Ark. Admin. Code 005.15.23-4.0; Ark. Admin. Code

005.15.23-5.0

California

Cal. Health & Safety Code § 120335; Cal. Health & Safety Code § 120370; Cal. Code

Regs. tit. 17, § 6025; Cal. Code Regs. tit. 17, § 6065; Cal. Code Regs. tit. 17, § 6070

Colorado

Colo. Rev. Stat. § 25-4-901; Colo. Rev. Stat. § 25-4-902; Colo. Rev. Stat. § 25-4-903;

Colo. Rev. Stat. § 25-4-908; 6 Colo. Code Regs. § 1009-2:II; 6 Colo. Code Regs. § 1009-

2:III; 6 Colo. Code Regs. § 1009-2:VI

Connecticut

Conn. Gen. Stat. § 10-204a; Conn. Agencies Regs. § 10-204a-2a; Conn. Agencies Regs.

§ 10-204a-3a

Delaware

14 Del. Code Ann. § 131; 14 Del. Admin. Code § 804; 16 Del. Admin. Code § 4202-7.0

Florida

Fla. Stat. Ann. § 1003.22; Fla. Admin. Code Ann. r. 64D-3.046

Georgia

Ga. Code Ann. § 20-2-771; Ga. Comp. R. & Regs. 511-2-2-.02; Ga. Comp. R. & Regs.

511-2-2-.04; Ga. Comp. R. & Regs. 511-2-2-.05; Ga. Comp. R. & Regs. 511-2-2-.06; Ga.

Comp. R. & Regs. 511-2-2-.07

Hawaii

Haw. Rev. Stat. § 302A-1156; Haw. Rev. Stat. § 321-11; Haw. Rev. Stat. § 325-124;

Haw. Code R. § 11-157 Exhibit B; Haw. Code R. § 11-157-3.05; Haw. Code R. § 11-157-5

Idaho

Idaho Admin. Code r. 16.02.15.010; Idaho Admin. Code r. 16.02.15.100; Idaho Admin.

Code r. 16.02.15.102; Idaho Admin. Code r. 16.02.15.110

Illinois

105 Ill. Comp. Stat. Ann. 5/27-8.1; Ill. Adm. Code tit. 77, § 665.240; Ill. Adm. Code tit.

77, § 665.510; Ill. Adm. Code tit. 77, § 665.520; Ill. Adm. Code tit. 77, § Adm. Code

698.50

Indiana

Ind. Code § 20-34-4-2; Ind. Code § 20-34-4-5

Iowa

Iowa Code Ann. § 139A.8; Iowa Admin. Code r. 641-7.3(139A)

Kansas

Kan. Stat. Ann. § 72-6262(b); Kan. Admin. Regs. § 28-1-20(b)

Kentucky

Ky. Rev. Stat. Ann. § 214.034; Ky. Rev. Stat. Ann. § 214.036; 902 Ky. Admin. Regs. 2:060

Louisiana

La. Stat. Ann. § 17:170; La. Admin Code. tit. 28, Pt CLVII, § 303; La. Admin Code. tit. 28,

Pt LXXIX, § 1101; La. Admin Code. tit. 51, Pt II, § 701

Maine

Me. Rev. Stat. Ann. tit. 20-A, § 6355; Me. Rev. Stat. Ann. tit. 20-A, § 6359; 05-071 Me.

Code R. Ch. 126, §§ 1, 3, 4, 5, and 6

Maryland

Md. Code Regs. 10.06.04.03; Md. Code Regs. 10.06.04.04; Md. Code Regs. 10.06.04.05

Massachusetts

Mass. Gen. Laws Ann. ch. 76, § 15; 105 Mass. Code Regs. 220.500

Michigan

Mich. Admin. Code r. 325.176

Minnesota

Minn. Stat. Ann. § 121A.15; Minn. R. 4604.0430; Minn. R. 4604.0600; Minn. R.

4604.0810; Minn. R. 4604.0900; Minn. R. 4604.1020

Mississippi

Miss. Code Ann. § 41-23-37; 7 Miss. Admin. Code T. 7, Pt. 8

Missouri

Mo. Ann. Stat. § 167.181(3); Mo. Ann. Stat. § 210.003; 19 Mo. Code Regs. 20-28.010

Montana

Mont. Code Ann. § 20-5-403; Mont. Code Ann. § 20-5-405; Mont. Admin. R.

37.114.703; Mont. Admin. R. 37.114.715; Mont. Admin. R. 37.114.716

Nebraska

Neb. Rev. St. § 79-221; 173 Neb. Admin. Code Ch. 3, § 008; 173 Neb. Admin. Code Ch.

3, § 009 (3-009.01); 173 Neb. Admin. Code Ch. 3, § 010

15

Nevada

Nev. Rev. Stat. § 392.435; Nev. Rev. Stat. § 392.437; Nev. Rev. Stat. § 392.439; Nev.

Rev. Stat. § 394.192; Nev. Rev. Stat. § 394.193; Nev. Rev. Stat. § 394.194; Nev. Rev.

Stat. § 392.446; Nev. Admin. Code § 392.105; Nev. Admin. Code § 439.897

New

Hampshire

N.H. Rev. Stat.141-c:20-c; N.H. Code Admin. R. He-P 301.13; N.H. Code Admin. R. Ed

311.01

New Jersey

N.J. Admin. Code § 3A:52-7.3; N.J. Admin. Code § 8:57–4.3; N.J. Admin. Code § 8:57–

4.4; N.J. Admin. Code § 8:57–4.6; N.J. Admin Code § 8:57–4.10; N.J. Admin. Code §

8:57–4.11; N.J. Admin. Code § 8:57–4.12; N.J. Admin. Code § 8:57–4.16; N.J. Admin

Code § 8:57–4.17; N.J. Admin. Code § 8:57–3.18

New Mexico

N.M. Code R. § 6.12.2; N.M. Code R. § 7.5.2; N.M. Code R. § 7.5.2.9; N.M. Code R. §

7.5.3; N.M. Code R. § 7.5.3.9

New York

N.Y. Public Health Law § 2164; N.Y. Comp. Codes R. & Regs. tit. 10, § 66-1.1; N.Y.

Comp. Codes R. & Regs. tit. 10, § 66-1.3; N.Y. Comp. Codes R. & Regs. tit. 10, § 66-1.5;

N.Y. Comp. Codes R. & Regs. tit. 10, § 66-1.6

North Carolina

N.C. Gen. Stat. Ann. § 130A-154; N.C. Gen. Stat. Ann. § 130A-155; N.C. Gen. Stat. Ann.

§ 130A-157; 10A N.C. Admin. Code 41A.0401

North Dakota

N.D. Cent. Code § 23-07-17.1; N.D. Admin. Code 33-06-05-01

Ohio

Ohio Rev. Code Ann. § 3313.671

Oklahoma

Okla. St. Ann. tit. 70, § 1210.193; Okla. Admin. Code § 310:535-1-2(d)

Oregon

Or. Rev. Stat. § 433.267; Or. Admin. R. 333-050-0010; Or. Admin. R. 333-050-0240; Or.

Admin. R. 333-050-0040; Or. Admin. R. 333-050-0050

Pennsylvania

24 Pa. Stat. and Cons. Stat. Ann. § 13-1303a; 28 Pa. Code § 23.82; 28 Pa. Code § 23.83;

28 Pa. Code § 23.84

Rhode Island

216 R.I. Code R. § 30-05-3.5

South Carolina

S.C. Code Ann. Regs. 61-8

South Dakota

S.D. Codified Laws § 13-28-7.1; S.D. Admin. R. 44:81:03:01; S.D. Admin. R. 44:81:03:02;

S.D. Admin. R. 44:81:04:01

Tennessee

Tenn. Code Ann. § 49-6-5001; Tenn. Comp. R. & Regs. 1200-14-01-.29

Texas

Tex. Education Code Ann. § 38.001; 25 Tex. Admin. Code § 97.62

Utah

Utah Code Ann. 1953 § 53G-9-301; Utah Code Ann. 1953 § 53G-9-303; Utah Code Ann.

1953 § 53G-9-304; Utah Admin. Code r. 396-100

Vermont

Vt. Stat. Ann. tit. 18, § 1122; Vt. Admin. Code 12-5-5:6.0; Vt. Admin. Code 12-5-5:7.0;

Vt. Admin. Code 12-5-5:9.0

Virginia

Va. Code Ann. § 22.1-12; Va. Code Ann. § 22.1-271.2; Va. Code Ann. § 32.1-46; 12 Va.

Admin. Code § 5-110-10; 12 Va. Admin. Code § 5-110-70; 12 Va. Admin. Code § 5-110-

80

Washington

WAC 246-105-030; West’s RCWA 28A.210.090; WAC 246-105-020; WAC 246-105-050;

WAC 392-380-020

West Virginia

W. Va. Code § 16-3-4; W. Va. Code R. § 64-95-4; W. Va. Code R. § 64-95-5; W. Va. Code

R. § 64-95-6; W. Va. Code R. § 64-95-7; W. Va. Code R. § 64-95-8; W. Va. Code R. § 64-

95-9; W. Va. Code R. § 64-95-14; W. Va. Code R. § 64-95-15; W. Va. Code R. § 64-95-

16; W. Va. Code R. § 64-95-17; W. Va. Code R. § 126-51-6

Wisconsin

Wis. Stat. Ann. § 252.04(3); Wis. Admin. Code DHS § 144.03; Wis. Admin. Code DHS §

144.04; Wis. Admin. Code DHS § 144.05

Wyoming

048.0071-3 Wyo. Code R. § 4; 048.0071-3 Wyo. Code R. § 7; 048.0071-3 Wyo. Code R.

§ 5

16

Appendices - Notes

i

Illinois law requires that, prior to entering the sixth grade, children receive three Hepatitis B

vaccinations. Ill. Admin. Code tit. 77, § 665.240(i)(2).

ii

Iowa requires that children be vaccinated for measles and rubella; a mumps vaccination is not

mandatory. Iowa Code Ann. § 139A.8.

iii

North Carolina also requires the Pneumococcal conjugate vaccine for entry into kindergarten. N.C.

Department of Health and Human Services, Immunization Branch. K-12 School Requirements (March 10,

2020).

iv

Nebraska law requires presentation of an “immunization history,” which includes the name of the

vaccine and the date of administration. 173 Neb. Admin. Code § 3-009.01.

v

New Hampshire requires “written authenticated evidence” of immunization. N.H. Code Admin. R. Ann.

He-P 301.13, 301.01(n).

vi

North Dakota law specifies that “other official proof of immunization” is also acceptable. N.D. Admin.

Code § 33-06-05-01.

vii

Texas notes that “any document will be acceptable provided a physician or public health personnel

[sic] has validated it.” Texas Dept. State Health Services. 2019-2020 Texas Minimum State Vaccine

Requirements for Students Grades K-12. Revised March 2019.

viii

Effective April 28, 2021, Connecticut law no longer provides for a religious exemption from required

school vaccinations, except for students enrolled in K-12 who had a religious exemption prior to that

date. Conn. Gen. Stat. § 10-204(a) (2021).

ix

Effective September 1, 2021, Maine repealed its religious and philosophical exemptions. 2019 Me.

Legis. Serv. Ch. 154.

x

An exception to the Washington state philosophical exemption is that it may not be used to exempt a

child from the measles, mumps, rubella (MMR) vaccine. Wash. Rev. Code Ann. § 28A.210.090.

xi

Medical exemptions require approval of the State Health Director only if based on a contraindication

not on the list adopted by the Commission of Public Health. N.C. Gen. Stat. § 130A-156.

xii

The citations in the table in Appendix D are state statutes and regulations relied upon for the tables in

Appendices A, B, and C. The list of state laws is not exhaustive: other statutes and regulations may be

relevant. In addition, PHLP reviewed and relied upon state school vaccination policy documents and

forms retrieved for the year assessed (2019-2020 school year). If you would like additional information

about these state documents, please contact PHLP at PHLawProgram@cdc.gov

.