BC Continuing Education Student COVID-19 Vaccination Attestation (Confirmation) Form

This form is interactive; the answers you provide will cause additional questions to appear. This form must be completed by October 4, 2021.

This form is only for Continuing Education students (including Tombolo, Community Education, and TELOS). If you are not a Continuing Education student, please use the main student form.
Identity Information



Not sure what this is? Look up your Student ID here.


Enter in MM/DD/YYYY format
Vaccination Status

Vaccination Confirmation

Partial Vaccination Confirmation

Exemption Request


Medical Documentation Required
Medical documentation is required, you will receive an additional email with a form that will need to be completed before exemption will be reviewed. Please monitor your Bellevue College email. 
Religious Exemption



Vaccination Information




Incomplete Vaccination Series

You need to complete your vaccination series. Please return and resubmit this form once you have both doses.
Your Vaccination Status May Result in Disciplinary Action
  • The answers you have provided above indicate that you are not fully or partially vaccinated, and that you have not requested a medical or religious exemption from taking the COVID-19 vaccination. 

    Students who do not submit an attestation/confirmation of vaccination or receive an exemption may be subject to disciplinary action if enrolled for Fall Quarter classes. If a student submits a false attestation, they may also be subject to disciplinary action that could include suspension or dismissal from the College.
By submitting this form I declare and confirm that the information provided is accurate and true and may be subject to verification by Bellevue College, the state, and local public health officials, including observing my CDC vaccination card, state immunization information system record, or other documentation.
By submitting this form I declare and confirm that the information provided is accurate and true and may be subject to verification by Bellevue College, the state, and local public health officials.
I understand that if the information I provided on this form is found to be false or inaccurate, I may be subject to disciplinary action.