How to Write and Submit an Indiana Religious Exemption Form for Adults

An Indiana religious exemption form for adults is a written, signed statement telling your employer or school that you decline a required vaccination or immunization because of a sincerely held religious belief. No single state-issued form covers every situation. Your employer or college may hand you a template, and if so, use it; if not, you can draft the statement yourself. For employer COVID-19 mandates, Indiana Code 22-5-4.6-6 spells out the right explicitly, and federal Title VII covers religious accommodations in the workplace more broadly.¹

What to Put in the Statement

For a COVID-19 vaccine exemption at work, the statute asks for one thing: a written statement indicating that you decline the immunization because of a sincerely held religious belief.¹ For other workplace accommodations under Title VII, the request just needs to put your employer on notice that a work requirement conflicts with your religious beliefs.

A workable statement includes:

Your full legal name, employee ID or department, and the name of the supervisor or HR contact who should receive the document.
The specific requirement you are objecting to, named precisely. If the employer’s policy has a title or number, reference it so there is no confusion about which rule you are declining.
A plain description, in your own words, of why complying with the requirement violates your sincerely held religious belief. You do not need a theological essay or scripture citations. Keep the objection on religious ground; do not frame it as medical, political, or scientific, because the legal protection attaches specifically to religious belief.
Your handwritten signature and the date. Indiana law does not require notarization for a workplace religious exemption, though some employer forms include a witness or notary line.

You do not have to belong to an organized religion. Under both federal and Indiana law, personal moral or ethical convictions that function like religious beliefs can qualify, as long as they are sincere. The EEOC allows employers to make limited inquiries into whether a belief is religious in nature and sincerely held, but those inquiries must be narrowly focused.²

How to Submit the Form

Delivery matters because disputes often come down to whether the employer actually received the statement, and when. Pick the method that produces a receipt.

If your employer uses an HR portal, upload the document and save the confirmation page or email. A timestamped system receipt is strong proof.
Certified mail with a return receipt gives you a postal record of delivery and the signature of whoever accepted it.
If you hand it over in person, bring a second copy and ask the recipient to sign and date it as acknowledgment.

Keep your own copy of the signed statement along with whatever proof of delivery you collected. If the timing or receipt of the request is ever questioned, that paper trail is your protection.

What Happens After You Submit

Indiana’s statute does not set a response deadline for employers. In practice, reviews usually run one to two weeks, longer at organizations that route exemption requests through a committee.

Expect the possibility of follow-up questions. The EEOC recognizes that employers may ask limited questions to confirm the belief is sincerely held and religious in nature.² What the employer cannot do is demand detailed theological proof or put your faith tradition on trial. Answer briefly and stay focused on the religious basis of your objection.

If the exemption is granted, the employer may condition it on alternative measures such as masking, periodic testing, or a modified work arrangement. These conditions are legally permissible as long as they do not effectively punish you for taking the exemption. Ask for written confirmation of the exemption and any conditions attached, and keep that document with your copies.

College and University Students

Adults enrolled at Indiana colleges and universities use a different track. Under IC 20-34-3-2, a religious objection exempts a person from required immunizations as long as the objection is in writing, signed, and delivered to the appropriate school official.³

Each institution runs its own process. Indiana University, for example, requires students to download a universal waiver form, complete and sign it by hand (typed signatures are not accepted), and upload it through their Med+Proctor account. Students who file a religious exemption at IU must leave campus if an outbreak of a listed preventable disease occurs on or near campus.⁴ Check your own school’s registrar or student health office for the exact form and submission steps. Unlike workplace requests, student exemptions generally are accepted on the signed statement without a back-and-forth review, but the outbreak restriction is the tradeoff.

If Your Request Is Denied

An employer denying a religious accommodation has to show that granting it would impose a substantial burden on the business, not a minor inconvenience. The U.S. Supreme Court set that standard in Groff v. DeJoy (2023), holding that an employer must show the accommodation would result in “substantial increased costs in relation to the conduct of its particular business.”⁵ If you are denied, ask for the reason in writing. A vague denial with no documented cost or operational impact suggests the employer has not met its burden.

Two agencies take religious discrimination complaints:

The Indiana Civil Rights Commission accepts complaints by phone at 317-232-2600 or online through its portal. The ICRC reviews jurisdiction, investigates, and may offer mediation.⁶
The EEOC accepts a federal charge of religious discrimination. Because Indiana has a state civil rights agency, the filing window is 300 calendar days from the date of the discriminatory act rather than 180. Do not wait for an internal appeal to finish; that clock runs no matter what the employer is doing on its side.⁷

Federal employees are on a shorter clock and must contact their agency’s EEO counselor within 45 days of the discriminatory action.⁷

Retaliation Protections

Requesting a religious accommodation is a protected activity. Under Title VII, an employer cannot fire, demote, reassign, cut pay, or otherwise punish you for submitting the request, and the protection reaches promotions, assignments, and training opportunities as well.⁸ Indiana’s own civil rights law bars religious discrimination in employment on the state level.⁹

If something changes after you submit the request, start documenting right away. Save emails. Note dates, times, and witnesses for any verbal conversations. Keep copies of altered schedules, reassignments, and performance reviews. A retaliation charge carries the same 300-day filing window at the EEOC as the underlying discrimination claim.⁸

1
Indiana General Assembly. Indiana Code 22-5-4.6-6 – Documentation Requirements
2
U.S. Equal Employment Opportunity Commission. Section 12: Religious Discrimination
3
Indiana General Assembly. Indiana Code 20-34-3-2 – Religious Objections
4
Indiana University. Immunization: Student Records: Registrar
5
Supreme Court of the United States. Groff v. DeJoy, 600 U.S. 447 (2023)
6
Indiana Civil Rights Commission. Indiana Civil Rights Commission Home Page
7
U.S. Equal Employment Opportunity Commission. Time Limits For Filing A Charge
8
U.S. Equal Employment Opportunity Commission. Religious Discrimination
9
Indiana Civil Rights Commission. Indiana Code 22-9-1 Chapter 1 – Civil Rights