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Memorandum for AFRC/CC — Subject: Religious Accommodation Request for Immunization Waiver (Document 2-11, Case 5:22-cv-00009)

Date
2022-01-06

Summary

A one-page template memorandum titled Religious Accommodation Request for Immunization Waiver, filed January 6, 2022 as Document 2-11 in Case 5:22-cv-00009-TES. The template is addressed to AFRC/CC with placeholders for letterhead, rank, name and unit, and its listed references include AFI 48-110 on immunizations. Its numbered paragraphs prompt the requester to identify a faith group, the accommodation sought, authoritative texts supporting the belief, and the sincerity of the request. It has the requester state an understanding that under AFI 48-110 the requester has a temporary exemption from vaccinations while the request is processed and will be counseled by a commander and a military physician, and it has the requester authorize the Chaplain to advise leadership on the request.

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Cite this document

“Memorandum for AFRC/CC — Subject: Religious Accommodation Request for Immunization Waiver (Document 2-11, Case 5:22-cv-00009).” Original at archive.org, dated 2022-01-06. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2022-01-06-covid-era-misc-d7e9a93d-1/, SHA-256 d7e9a93da34e159b72f27121c32915411cd556643a330c4d15caf413f69ea251.

Full text

          Case 5:22-cv-00009-TES Document 2-11 Filed 01/06/22 Page 1 of 1


                                          YOUR LETTERHEAD
                                            YOUR LETTERHEAD




                                                                                                                     Date

MEMORANDUM FOR AFRC/CC
               MEMBER’S CC

FROM: RANK, NAME

SUBJECT: Religious Accommodation Request for Immunization Waiver

References: (a) DODI 1300.17, Religious Liberty in the Military Services, 1 Sept 20.
            (b) AFI 1-1, 7 Aug 12, Air Force Standards.
            (c) AFI 48-110, 16 Feb 18, Immunizations and Chemoprophylaxis for the
            Prevention of Infectious Diseases.
            (d) AFPD 52-2, 28 Jul 20, Accommodation of Religious Practices in the Air Force.
            (e) DAFI 52-201, Religious Freedom in the Department of the Air Force, 32 Jun 21.

1. I, (Rank, Name), (Unit), AFSC ####, DOD ID ##########, request a religious accommodation waiver from
immunization for the reasons set out below.

2. As a member of the (name of faith group), I am requesting a religious accommodation for (whatever the
accommodation is), in accordance with AFI 48-110, paragraph (AFI reference). In my opinion, the request will not
interfere with my primary duties, which include (list duties).

3.The authoritative texts or tradition for my beliefs include (list a few). Among them include several passages,
teachings, or historic examples illustrating that I should (list the requested accommodation). They include (give a
few brief quotes and their sources).

4. (Write a brief paragraph that demonstrates the sincerity of the request. This may include length of time in the
faith tradition, activities that require the exemption, the process by which you came to this decision, etc.)

5. I understand that IAW AFI 48-110 I have temporary exemption from vaccinations while my request is being
processed. I also understand that I will be counseled by my commander and a military physician regarding: the
diseases concerned; specific vaccine information including product constituents, benefits, and risks; and potential
risks of infection incurred by unimmunized individuals. They must determine that I am making an informed decision
and fully understand that my request may have an adverse impact on my deployability, assignment, and/or
international travel.

6. I waive my privilege to this communication only and authorize the Chaplain to advise my leadership with
regard to this request and only this request. I understand that my request will reach AFRC/CC staff NLT 30/60 days
from the date of this memorandum as I’m in active duty status CONUS/active duty status OCONUS/reserve status.

7. If you have any questions, please contact (rank, name) at (duty contact number) or (duty e-mail).




                                                                NAME, Rank, USAF
                                                                Duty Title

File and source

File
gov.uscourts.gamd.123364.2.11.pdf
Size
370,089 bytes
SHA-256
d7e9a93da34e159b72f27121c32915411cd556643a330c4d15caf413f69ea251
Our copy
gov.uscourts.gamd.123364.2.11.pdf
Original
archive.org
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