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COVID-19 Student Exemption & Relief Request

If you were unable to graduate, seek licensure and/or secure employment due to either local or State restrictions or for other reasons associated with the COVID-19 Pandemic please complete the following form.

Student Full Name(Required)
Please select the reason you were unable to graduate, seek licensure and/or secure employment due to either local or state restrictions that may have been in place during the reporting period, or for other reasons associated with the COVID-19 Pandemic.
I understand that my signature certifies and affirms that the information provided by me is true and correct to the best of my knowledge.I understand that my electronic signature shall have the same force and effect as my written signature.
Max. file size: 100 MB.
This field is for validation purposes and should be left unchanged.