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FROM: ___________________________ (employee)
DATE: ___________________________
To Whom It May Concern:
Please allow this memorandum to serve as my request for a religious and medical
exemption from your COVID-19 vaccination requirement.1
Request for religious exemption
First, this request is one to reasonably accommodate my religious beliefs. Title VII (42
U.S.C. 2000e) requires employers to offer reasonable accommodations for religious beliefs.
Having studied the COVID-19 vaccines, I have a sincerely held religious belief against using any
product whether, in research or development, or production, that utilized aborted fetal tissue.
Pfizer and Moderna performed confirmation tests (to ensure the vaccines work) using fetal cell
lines. Both companies used the fetal cell line HEK 293 in the confirmation phase to ensure the
vaccines work. All HEK 293 cells are descended from tissue taken from a 1973 elective abortion
that took place in the Netherlands. Johnson & Johnson uses fetal cell lines in vaccine
development, confirmation and production. To make their virus vector vaccine, Johnson &
Johnson infects PER.C6 fetal cell line cells with adenovirus. All PER.C6 cells used to
manufacture the Johnson & Johnson vaccine are descended from tissue taken from a 1985
elective abortion that also took place in the Netherlands.
Thus, the current vaccines on the market, if used by me, burdens my sincerely held
religious beliefs.
I previously have had COVID-19, and all available evidence suggests robust natural
immunity from having had it, that may, some research reveals, be more robust and longer lasting
than any vaccines.2 Thus, I pose no additional risk to my co-workers, and should, as a
consequence, be accommodated for my request for an exemption. Paperwork documenting my
previous infection is attached. Commented [CW1]: This language and footnotes to it
should only be used if you have previously had COVID-19
and recovered.

As an aside, current medical research reveals that COVID-19 vaccines are not preventing
community spread with respect to the currently prevalent Delta Variant, but are, instead,
symptom suppressants. (last visited
2 (last visited 8/14/2021); (last
visited 8/14/2021); (last visited 8/14/2021).
I offer, as an accommodation, to comply with requirements related to health and safety,
including wearing PPE if requested, undertaking sanitization and other procedures if requested,
and to report if I feel ill.
Request for medical exemption
I also request a medical exemption. I have a disability, which is defined as “a physical or
mental impairment that substantially limits one or more major life activities of such individual.”
42 USC 12102(1)(A). That disability is my lack of vaccination status. It is clear that this
condition substantially limits one or more major life activities of such individual, and in fact,
your mandate is evidence of the inability to work without the vaccination. Employers may not
discriminate on the basis of a disability. 42 USC 12112.
I have attached a physician’s note, as well, concerning the recommendation that I not be
vaccinated. I thus request that you reasonably accommodate my lack of vaccination, and provide
other options so that I can continue to be [employed/remain in the program/remain in school].
COVID-19 Emergency Use Status
I understand that you are requiring me to receive a COVID-19 vaccine as a condition of
employment. At present, all COVID-19 vaccines are approved for emergency use authorization
only. That statute is contained at 21 U.S. Code § 360bbb–3. Approval is conditioned, however,
on individuals who are subject to receiving the vaccine having “the option to accept or refuse
administration of the product,” and being informed “of the consequences, if any, of refusing
administration of the product, and of the alternatives to the product that are available and of their
benefits and risks.” 21 U.S. Code § 360bbb–3(e)(1)(A)(ii).
Kentucky recognizes a discharge in violation of public policy claim. That requires the
employee to show: (1) the discharge is contrary and well-defined public policy as evidenced by
existing law; and (2) the policy in question is evidenced by a constitutional or statutory
provision. Grzyb v. Evans, 700 S.W.2d 399, 402 (Ky. 1985). Grzyb also recognized that a
discharge of an employee was not permitted for an employee exercising a “right conferred by a
well-established legislative enactment,” and doing so would be actionable.
Again, I request a accommodation from your policy for so long as the vaccine remains
approved only under emergency use authorization status.


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