Immunization Fee Appeal

If you have been charged an immunization fee ($100) and you would like to contest the fee, please fill out and submit this form.

Please note: There is no registration hold for the immunization requirement. You will not be able to register if you have an outstanding balance on your student account. HPS staff suggests paying your balance due to register and then file an appeal. If your appeal is approved, you will be refunded the late immunization fee.

Your Name:  
Your Student ID:  
Email Address:  
Please explain the reasons for the appeal: