• Guidelines for Requesting an Exemption for Reasons of Conscience

     * Written requests must be submitted through the U.S. Postal Service, commercial carrier, fax, or by hand-delivery.

     Mailing Address:

     Immunization Branch

     Department of State Health Services
     Immunization Branch (MC 1946) 
     P.O. Box 149347
     Austin, TX 78714-9347

     Hand Delivery:

     Department of State Health Services 
     Immunization Branch (MC 1946)
     1100 West 49th Street
     Austin, TX 78756
     Fax: 512.458.7544

     * Hand-delivered requests may be submitted to the DSHS, Immunization Branch, between 8 a.m. and 5 p.m. Mondays through Fridays. ALL affidavit forms will be mailed to you via U.S. Postal Service. No requests will be filled at the time of hand-delivery.

    * Affidavit form requests will be processed and mailed within one week from the receipt of the request. If additional information is needed in order to process the affidavit, you will be notified.

    * The letter must include the following information:

        - Full name of each child for whom a form is requested (first, middle, and last);

        - Date of birth of each child for whom a form is requested;

        - Parent or legal guardian's signature and complete return mailing address, including zip code;

        - Number of forms needed for each child (not to exceed five forms per child)

     
    * Electronic mail or telephone requests cannot be processed.

    * The official Texas Department of State Health Services affidavit form must be notarized and submitted to school officials. The form must be submitted

    within 90 days from the date it is notarized.

    * The school will accept only official affidavit forms developed and issued by the Texas Department of State Health Services (DSHS), Immunization Branch.

     No other forms or reproductions will be allowed.