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Student Face Covering Exemption Form

Jordan School District recognizes that some students may have a medical condition, mental health condition, or disability that prevents wearing a face covering.

In order to receive an exemption from the State’s face covering requirements, the form found at the link below must be completed and returned to the school your child attends prior to your student attending school without a face covering.

Please have your primary care provider complete the Medical Certification by doing one of the following:

  1. Complete and sign the Medical Certification found at the link below.


  1. Attach an email or note from the primary care provider outlining the same information as indicated below to this completed form.

COVID-19 Student Face Covering Exception Request & Medical Certification