Immunization Late Fee Appeal Form

Immunization Record Late Fee Appeal

If you believe there are extenuating circumstances that prevented you from submitting completed immunization records on-time, you may submit an appeal for the Immunization Late Fee once all of your immunization records are completed and submitted using the online form only. Appeals will not be accepted via email. For late fees placed in October 2020, the appeal submission deadline is November 1 of the same semester. For late fees placed in January, the appeal submission deadline is March 1st of the same semester.

Please explain your reasons for requesting an appeal of the immunization record late fee. Allow at least 5 business days after submission for review of your appeal request. Student Health Services may request additional information regarding your appeal.

Immunization Late Fee Appeal Form

  • Responses will only be sent to a Mason email address (for example, @gmu.edu or @masonlive.gmu.edu).
  • Date Format: MM slash DD slash YYYY
  • Please explain your reasons for your appeal of the immunization record late fee.
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