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Arkansas Department of Health

4815 West Markham Street ● Little Rock, Arkansas 72205-3867 ● Telephone (501) 661-2000



Arkansas Immunization Exemption Application

The Arkansas Board of Health requires that all children attending childcare facilities and public or private schools in the State of Arkansas be immunized against vaccine-preventable diseases and also requires that all students attending colleges and universities in the State of Arkansas be immunized against measles, mumps, and rubella.

The Arkansas Department of Health is authorized by Act 999 of 2003 to grant individual exemptions from the immunization requirements. This website allows you to submit an application for exemption. The application may be completed by parents or guardians of students or by students who are 18 years of age or older. An application requesting an exemption must be submitted for each child or student. An application with a notarized signature of the parent/guardian, or the student over 18 years of age, must be submitted each school year to the Department of Health. Only a valid Immunization Exemption Application will be accepted for the school year. When approved, exemptions will be effective for the start of the Fall session and go through the Summer sessions.  

As part of the application, the law requires that the parent/guardian or college student complete an educational activity when requesting an exemption. The required educational activity can be met by reading the included Vaccine Information Statements from the Centers for Disease Control and Prevention. These statements provide information about the required vaccines. You are asked to sign that you have reviewed the Vaccine Information Statements, that you understand the risks and benefits of the vaccines, and that you still choose to request an exemption.

Please complete your Immunization Exemption Application, print it, sign it, have it notarized, and return it to the Arkansas Department of Health Immunization Section. We will send you a letter of approval or denial within ten working days of receiving a completed application. If your application is not complete, we will send you a checklist showing the reason(s) we were unable to process your application. You will then need to include the requested information and return the updated application for processing.    

After you have received your approval letter, you are responsible for notifying the student’s daycare, school, college, or university that your exemption request has been approved. You are responsible for retaining the original letter. A copy of the approval letter is to be placed in the student's file at the daycare/school or the college/university. 

Release of information will be provided only to the custodial parent/guardian or student over 18 years of age who completes this application and according to the notarized signature.

Thank you for using our online Immunization Exemption Application module.  To apply, please view the brief Introduction video below.  After the video, you will have access to the application form.  (This application works best in Google Chrome.)

NOTE:  You MUST have access to a printer before you start the online application process.  The notary page must be printed, signed, notarized and submitted back to ADH before processing can be complete.  If you do not have access to a printer, you will need to complete the paper form of the application.

Introduction Module